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This is an incredibly informative (and entertaining) podcast about one of the more unusual (like many other) PJ deployments. In this case it was to support the most critically hit NYC hospital that made national news, and the brave Doctors, Nurses, techs and staff showing up every day not fully knowing the risk they were taking, and if the protective gear was going to work, and then in most cases going home to their families.
We will hit on prepping the battlefield, PFC, critical care, and highlight the "FID" type response to support the NY ("indig") medical providers in a war with a new enemy that we are still learning how to battle.
PJNY- THAT OTHERS MAY LIVE
Check out the new MCTI- mission critical team institute podcast by Dr Cline and Coleman Ruiz
TOML
Hear the perspective of the Flight Doc providing medical C2 overhead in the C-130 and taking care of AR.
Doc Becker is an Emergency Medicine Doc at Stanford. We also discuss trismus in the field with TBI and airway management.
PJ Jon from the 131st discusses the mission and the medicine.
Use this as an sTBI pack out:
1. Hypertonic saline
2. Oxygen
3. Airway management kit, ventilator and monitor
4.RSI drugs
5. Versed
6. Kepra IV and PO
7. Glucometer, dextrose, glucose
8. Oral and rectal thermometer
IN AUG 2018 US Forces and Afghan partner forces were ordered to retake Ghazni from the Taliban. The details are described in an AUG 23, 2018 in TIME Magazine in an article entitled "Inside the US Fight to save Ghazni From the Taliban".
Nate is an 18D and Gavin is a PJ who supported ODA 1333. They discuss details of the mission and the medicine. There were over 40 casualties over the duration of the fighting with several MCIs.
This is the first of several episodes to discuss the prolonged operation.
Ret. CMSgt Doug Isaacks had a full career as a PJ and served twice as the Commandant for INDOC. He made significant strides in optimizing and modernizing training and selection.
This is a wonderful, heartfelt and enlightening discussion with a thoughtful leader on his reflections of being the Commandant of INDOC, and the challenges of running assessment and selection for a critical career field.
We hope this inspires PJs to consider tours in the pipeline because of the absolute importance of training our next generation of operators. And also impress upon young operators the gravity of these leadership roles, and to aspire to greatness in operations and leadership!
THAT OTHERS MAY LIVE
Also getting back to basics to review some medicine over next couple of months.
Will continue to track COVID relevant issues./
TOML
0-6 USAF , Baltimore Shock Trauma Anesthesiologist and Intensivist Doc Galvagno has been training PJs during the pandemic.
This is an update on the evolution of knowledge and thinking on 15 APR.
Rich is a Physical Therapist working with the 123rd HPO team.
He discusses the evolution of HPO in KY as well as observations about tactical athletes.
Catch his podcast "The Peak Performance".
We close with a few comments and update about COVID in NYC.
THAT OTHERS MAY LIVE
Dr Phil is an ER Doc on Long Island who has been teaching PJs for about 5 years.
He has been working COVID for a month now and shares some reflections now-
Check PJ MED channel on you tube for COVID vent lectures.
Check pjrqmed on instagram for updates on the SOF NYC response.
The Ryan Larkin Field Hospital at NY Presbyterian opened today! Congrats to Missy Givens, Ricky, Kate and Dr Hill and the team at NYP!
Doc Bellehsen is a Psychologist who works with Veterans and Mil Members. He has provided great support to our Team and our Wing.
Doc discusses a variety of issues relevant to you and your family during extended stay at home periods.
Follow intel on our SOF NYC COVID response on this podcast and now on instagram at pjrqmed.
We also have COVID lectures for PJs and Medics on YouTube on a new PJ MED channel.
THAT OTHERS MAY LIVE
We will use PJ Medcast and PJ MED or pjrqmed on instagram to keep you apprised of developments for the over 600 volunteers for the SOF Medical Response to the NYC COVID battle.
THANK YOU TO ALL OF YOU WHO STEPPED UP!
The Ryan Larkin Field hospital with NY Presbyterian Hospital is staffed and we will now focus on supporting more hospitals around the city.
We also hope to create a reproducible model to respond to other cities as they become stressed.
We will use this platform to keep you updated and let you know how you might be able to help.
sign up with this form:
https://docs.google.com/forms/d/e/1FAIpQLSfOQDDxjznVjvwwvpC2lWEXSd8WKAeUkbjINGIA3clmGII-gg/viewform
PJs are in the fight tomorrow...PJNY
THAT OTHERS MAY LIVE
The new 103rd Flight Doc is a Brooklyn ER Doc.
He shares early lessons learned on COVID.
Dr Romaguera's work focuses on the children of our service members and has provided a lot of support to the 103rd Rescue Squadron over the years.
Doc Romaguera discusses how to communicate with your children about COVID and what to look for while staying at home for prolonged periods.
If you like this and find it helpful please email me if there are other issues you would like her to address.
THAT OTHERS MAY LIVE
Intro to basic info on COVID
Prepping ANG PJs if needed to support
Will try to keep this as a concise repository of useful intel and background for operators and your families
Stay safe- distance-hand wash - use PPE meticulously- solve problems!
THAT OTHERS MAY LIVE
Col S continues her discussion with the future organization of combat trauma systems.
Everybody be safe and use common sense.
Our hearts go out to the family, friends and brothers of the Marine Raiders.
That Others May Live.
Col Shackelford is an AF Trauma Surgeon and Director of the Joint Trauma System. She is an important friend of the community.
In this episode she discusses how the DOD looks at and organizes its approach to trauma care and improving it. This is mission critical intel for PJs and SOF medics and why its so important to document care.
THAT OTHERS MAY LIVE
Doc Dubose is an experienced AF Trauma Surgeon with decades of GWOT experience.
Col D discusses the trauma surgeon's perspective on incoming chest trauma, and things for PJs and Medics to think about.
THAT OTHERS MAY LIVE
Easily one of our best vent podcasts. Good sound! We are in the process of fixing the sound (of course by a NY PJ- not me).
This talk covers the basics but also blast lung, TBI and trouble shooting from an experienced respiratory tech with deployments under his belt. He is currently at Baltimore Shock Trauma where we have a great rotation going. Your Flight Doc knows how to get you set up.
Notes from Sgt Noll-
Vent Bullet Points
BASICS
Initial calculation for TV is 6ml/kg
increasing RR or TV lowers C02
decreasing RR or TV increases C02
increasing fio2 increases pao2 and sat
increasing peep will increase pa02 sat o2 sat
initial peep setting on vent is usually 5, can increase 1-2 at a time to 12 maximum
CONTINUOUS SEDATION
Primary indications for resedation of intubated Pt:
Increased HR, Increased BP,
Is Pt diaphoretic? Bucking?
Consider using “Boom stick” Take a 10cc syringe if Flight Doc approved:
Draw up 3cc Ketamine (150 mg) Draw up 5cc Fentanyl (250 mcg) Draw up 2cc Midazolam (10 mg)
Recommend a 1cc push PRN every 10-15 mns
Re-paralyzing the intubated patient:
sTBI Patient – consider re-paralyzing w 100mg ROC if:
continuous bucking and not responding to sedation and is hypertensive.
Management of intubated patients (pulmonary contusion, blast lung, sTBI,)
Pulmonary contusions:
S/S: hypoxia, build up of fluid (blood) in lungs, high PIP ie: above 30 or 35 (if no DOPE issues) -Can be bi-lateral but more often unilateral from blunt force trauma
TX:
-increase Fio2
-If contusion is unilateral (only one side is affected) consider placing in recovery position with the “good” lung down (more blood will go to the lung)
-consider lowering TV and increasing RR in order to maintain proper minute ventilation Blast Lung
BLAST LUNG
S/S:
-hypoxia, dyspnea, cyanosis, increased Etco2
-high PIP over time as lung compliance decreases
-reverberations for the blast can damage AC (alveolar capillary) membrane
-damaged alveoli become damaged and cannot get rid of C02 properly
TX:
- increase fio2
-consider lowering TV and increasing RR (note: this is only temporary as Pt will clinically deteriorate as compliance will be poor)
sTBI
S/S per PJmed handbook
Tx: per PJmed handbook
Vent: maintain target 35-40 etco2
COMPARING THE IMPACT 731 AND SAVe II
Impact 731
Pros: manipulation of I:E times, advanced synchronization settings, can detect patient effort and be triggered by Pt, can maintain 100% fio2 w supplemental O2, can be used down to a 5 kg Pt
Cons: weight and cube size, complicated to use if not current, must manually calculated weight/size of patient
SAVe II
Pros: Small, light, automatically populates initial settings after pushing Pt height, simple to use Cons: Does not detect patient effort resulting in patient-ventilator “desynchrony”
THAT OTHERS MAY LIVE!