The PJ Med Director and the PJ Medical Programs Manager discuss Ten key changes to the new handbook.

The handbook is being formatted and then out for print with the Journal of Special Operations Medicine.

DO NOT INSTITUTE THESE UNTIL THE HANDBOOK IS RELEASED OR YOUR FLIGHT DOC DIRECTS YOU TO.

1. Updated MARCH assessment to align w/ JTS TCCC guidelines
   1. Moved pelvic binder to circulation, specified how/how not to assess pelvis
2. Combat/Hemorrhagic Shock and blood protocol
   1. TXA – 2gm (1 minute slow IV push)-also used for suspected TBI
   2. cold stored type 'O' whole blood>fresh low titer-'O' whole blood >PRBCs and plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type specific fresh whole blood
   3. added 10mL of 10% calcium gluconate
3. “bougie assisted cric” method
4. Added vent troubleshooting and adjustment guide
5. General fluid guidance
   1. Omitted Hextend
   2. LR is primary crystalloid for non-hemorrhagic shock casualties (may still carry 100CC for med recon)
   3. Removing 3% Saline (see TBI protocol update)
6. TBI
   23. Replaced 3% Saline with 30mL of 23.4% hypertonic saline (learn the technique first)
   24. Versed for active seizures, Keppra for prophylactic (depressed skull fx/penetrating head wounds)
7. Procedural Sedation
   1. Replaced procedural analgesia w/ procedural sedation and provided protocol
   2. No longer promoting ketamine/fentanyl/versed rotation
      1. Dilauded f/ long term pain control in hemodynamically stable
      2. Ketamine for unstable
   3. Medications added to formulary to support ATP small unit care capability/modified TMEPS
      1. Famotidine (Pepcid) – Zantac replacement
      2. Amoxicillin
      3. Azithromycin
      4. 1% Hydrocortisone cream
      5. Metronidazole (Flagyl)
      6. Malarone/primaquine
      7. Ciprofloxacin
      8. 4% saline
   4. Medications removed
      1. Albumin
      2. Ranitidine (Zantac)
   5. CBRNE updates
      1. Added CRESS acronym (Consciousness, Respirations, Eyes, Secretions, Skin)-NATO method
      2. Added MARCH Squared
      3. Updated Cyanide Antidote
         1. Hydroxycobalimin, Sodium thiosulfate and activated charcoal

Doc Dorsch then gives us an ATP update amongst other intel.

THAT OTHERS MAY LIVE

Insightful discussion with Brian and Aaron from Ones Ready. Hear about the podcast and insights from their careers and time at A & S.

Support our Operators at: PararescueFoundation.org

Follow instagram pjrqmed, and on the internet at pjmed.com

THAT OTHERS MAY LIVE

CAPT (RET) Butler received this award from the American College of Surgeons.

Thanks for pushing this podcast over 1 million downloads!

Think of krazy / super glue for painful cracks in the heels and around nail beds.

THAT OTHERS MAY LIVE

PJ Jon discusses the mission, stroke and it relevance to sTBI management.

THAT OTHERS MAY LIVE

This discussion represents an excellent primer into how ketamine and fentanyl are interacting with the brain.

Thanks to Dr Perusine and for her work at neurovationlabs.com

Dr Jen Perusini explains her discovery with the labs she has worked at on some of the basic brain biochemistry of PTSD. She discusses basic science research establishing localization of increase in distinct pathways in the fear center of the brain, the amygdala.

I am posting this unusual basic science discussion because Dr Persuini explains it a meaningful way. She discusses where they are in the effort to begin human clinical trials. In discovering the the possible mechanistic target for PTSD, they are able to begin to craft a trageted therapeutic response. Hear about the promising work Dr Perusini is doing on behalf of our Warriors.

It covers information that is the prelude to next weeks podcast re: some of the actions related with ketamine and fentanyl.

Find out more:

neurovationlabs.com

THAT OTHERS MAY LIVE

Chris discusses providing extremely remote medical support in up to 80-100 degrees below zero.  Med planning, Evac, etc.

The program is through the University of Texas Medical Branch and the Center for Polar Medical Operations. They support the National Science Foundation.

Note- Chris is not officially representing the Univ of Texas or in any other official capacity. He is sharing his experience and letting our community know about this unique contracting opportunity.

Find info at :

https://www.utmb.edu/polar

THAT OTHERS MAY LIVE

USAF Pararescuemen (PJs) perform daring and unique rescues. Among the most unique are long range (>300 miles) ocean rescue missions accomplished by parachute insertion or helicopter using aerial refueling.

Learn about the infil and med details of these missions. This podcast is based on the article we published in the Journal of Special Operations Medicine.

THAT OTHERS MAY LIVE

Last week the 212th responded to a hunter who fell 100 feet down a slope and experienced significant skeletal trauma.

Dan reviews the technical and sometimes heinous rescue in unforgiving terrain during a windy, freezing rainstorm. 

Pearls-

1. To help dial in a diagnosis of sTBI- can the patient follow commands?

2- Med care in the elements focuses on hypothermia management and pain control to get into a place you can treat vs. thickets where it is impossible.

212th RQS!!! THAT OTHERS MAY LIVE

Mt Sinai Icahn School of Medicine Flex Program

Hofstra Zucker School of Medicine Direct admissions for SOF, no MCAT if qualified

Intro to 23.4 hypertonic saline for brain herniation in the field

Teaser on MCI research

THAT OTHERS MAY LIVE

A sailor fell ~35 feet on a ship in the Pacific- way out. Jump mission, 48 hrs PFC for spine, pelvis and extremity trauma, helo hoist off with multiple ARs. 

Stay tuned for the 212th high angle mish coming up...

THAT OTHERS MAY LIVE 

Dr Christine Sanchez is a SOF Performance Psychologist with over a decade of experience. She is an asset available to Guard and Reserve Teams, as well as AD, as a consultant.

5 Habits of High Performers to maintain cognitive bandwidth (direct focus & self-regulate psychophysiology)

Travis is a TCCC Committee member, and prior Pararescue Medical Programs Manager.

Travis is reviewing the TCCC Airway guidelines and found some surprising literature and details about the basics.
This is a great discussion reflecting a lot of detective work.

Thanks to Travis for dong this, emphasizing how important it is to question and validate what we do.

THAT OTHERS MAY LIVE

Sleep consistency

Cool Dark Quiet

Don't eat meals within 2-3 hours of sleeping

Find what time of day exercising is best for you- upon waking may be best

Go to sleep as soon after your shift that you can

Thanks to WHOOP for allowing us to use their email briefs

You can find data and more info at whoop.com and click on THE LOCKER

Check out Preston Cline and Coleman Ruiz on their podcast and website at Mission Critical Teams Institute.

Improving performance for special teams, from an academic and Tier 1 perspective.

Website:   MissionCTI.com

Check out their podcast at MCTI TEAMCAST

PJ Ian discusses the diagnosis of mTBI in austere operational and training environments, operational relevance, importance to post service records, considerations regarding reaction time, and a new  tool on the horizon to assist medics.

THAT OTHERS MAY LIVE

Ian discusses the limitations of diagnostic options in the field for mild TBI ( concussion) despite the frequency in training and on Ops.

Ian then lets us know about a new research tool leveraging reaction time as a potential solution for FOBs, in garrison training, clinics and other hardened facilities you may be responsible for Operators.

THAT OTHERS MAY LIVE

Doc Derwae was an OSS Rescue Doc at Nellis and then completed a residency in Dermatology at U PENN. She is now an USAF Dermatology Attending.

Here she discusses the science behind sun damage to the skin and risk of skin cancer. The cumulative injury to the skin over a career is real and preventible.
Skin protection from the sun is analogous to HPO programs and injury prevention and reduction to improve your lifetime health. It is also important to understand to protect your children.

If you have questions for Doc Derwae you can reach her through your Flight Doc.

THAT OTHERS MAY LIVE

In April 2020 NYC was overrun by COVID. 
New York Presbyterian (NYP) Medical Center comprised of several hospitals including Columbia and Cornell, exceeded capacity with COVID patients and created an overflow location on their football field in a bubble. Through personal relationships it was proposed that a social media call be made to recruit SOF medics to staff the field hospital. NYP agreed and this successfully occurred and became the Ryan Larkin Field Hospital at NYP.

NOTE- the medics came outside their military status as volunteers, but were soon integrated into the NYP staff.

From that, NYP tasked some of the medics to run another COVID ward, but inside the Columbia University Milstein Hospital.

This is the remarkable story of SOF Medics working in conjunction with civilian providers to support this world class hospital during a surge.

This model is a feasible approach to address surge needs in the Nation to hire military medics to work to their capability and become force multipliers for our healthcare providers who become overwhelmed and understaffed. SOF and other mil medics are a trained and reliable force, who come to the fight with humility and willing to do what is needed to support patient care.

Black mambas and cobras at some camps

thanks Dr Abo

Get POLYSERP for Africa

Check out the Asclepius Snakebite Foundation:

www.snakebitefoundation.org

Great PDF presentation:

https://jts.amedd.army.mil/assets/docs/presentations/Austere_Snake_Envenomation_Management_Presentation_Asclepius_Snakebite_Foundation.pdf

Prior Ranger and Ranger PA, and extremely effective medical policy writer and educator, Andy Fisher, M.D.  just reviewed the state of the art for pain control, i.e. analgesia, for the TCCC Committee.

Besides discussing basic ideas such as the difference between analgesia and sedation, Dr Fisher reviews pharmacology and his thoughts on best practices on the X and beyond.

I cannot emphasize enough how Andy's perspective from his experience on innumerable operations, combined with his keen intellect, are unique and very meaningful.

THAT OTHERS MAY LIVE