Advertise on podcast: DUSTOFF Medic Podcast

Sgt. 1st Class Christopher A. Celiz was awarded the Medal of Honor for heroic acts during an engagement with the enemy in Paktia Province, Afghanistan, on July 12, 2018. SFC Celiz saved the life of a wounded soldier from a partner force, and later used his body as a shield to cover the DUSTOFF aircraft that arrived to retrieve the wounded. SFC Celiz was mortally wounded during the engagement. In this episode, we talk with the lead flight medic and pilot in command of the aircraft present that day.  SFC Celiz is an American hero, and his actions saved many lives. The DUSTOFF crew from had a unique perspective, and by hearing from them we can both gain first-hand insight into SFC Celiz's bravery, and honor his memory.

Dr. Haney Mallemat, a triple-boarded critical care physician and Editor-in-Chief at criticalcarenow.com, joins us to discuss all things vasopressor related. During the interview, Dr. Mallemat mentions the Arginine Vasopressin During the Early Resuscitation of Traumatic Shock (AVERTShock) trial. You can find a summary of that study here, and deployedmedicine.com has a good video discussing the trial as well. Dr. Mallemat also mentions a study describing a "central line-less" ICU while discussing the safety of vasopressin administration through peripheral IVs. You can find that study here: Cardenas-Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of hospital medicine, 10(9), 581–585. https://doi.org/10.1002/jhm.2394

There's a new Training Circular 8-800, Medical Education & Demonstration of Individual Competence (MEDIC), and it is a major change from the last version. This episode is a deep dive into the new TC with the primary enlisted authors, MSG Kaleb Twilligear and MSG Hunter Black. Listen up as they talk about returning the responsibility for a ready medical force to the NCO level. Much of the conversation involves focusing on basic skills, from TCCC at deployedmedicine.com, to the 8-Step Training Model, to Troop Leading Procedures, the 68W STP, and even the Warrior Tasks and Battle Drills in STP 21-1-SMCT. F2s are the most highly trained medics in the conventional force, and we have a responsibility both as medics and NCOs to be familiar with these documents and ensure that we are meeting the standards they set forth. The conversation also includes some strategies on how to work with your leadership on improving medical training at your unit, with a mention of a study linking a provider's familiarity with TCCC to the proficiency of the medics they supervise. There's also a discussion of a study from the Government Accountability Office detailing shortcomings in military medical training. Have a listen and let us know what you think!

Dr. Steven Schauer returns to the podcast with Trevor and Morgan to talk about pain management. Managing pain is a complex topic involving both different types of pain and different medications. During the conversation, Dr. Schauer mentions JTS CPG 61, Analgesia and Sedation Management During Prolonged Field Care. You can find this on the link at our website, or by searching "JTS CPG." Military members, use your free UpToDate access to read their article entitled "Pain Control in the Critically Ill Adult Patient." If you don't have UpToDate access yet, read the article at nextgencombatmedic.com on how to get an AVL account. It's worth your time. Finally, Dr. Schauer mentions an article he co-authored last year: Bebarta, G. E., Bebarta, V. S., Fisher, A. D., April, M. D., Atkinson, A. J., McGhee, L. L., & Schauer, S. G. (2021). An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital. Military medicine.Have a listen, and let us know what you think!

Dr. Sean Stuart finishes up a discussion on chest tubes with Claire and Morgan. This episode discusses some of the finer points of the procedure. Dr. Stuart also describes how to make an inexpensive task trainer so you can practice thoracotomies at your unit.  Finally, he describes an improvised Heimlich valve that you can make with an exam glove if you're in a pinch and don't have a chest drain system immediately available. Photos on our website! Have a listen and please let us know what you think!

Dr. Sean Stuart joins Claire and Morgan for the first in a two-part series about chest tubes. Dr. Stuart is a Navy emergency medicine physician and is the Research Director of the Combat Trauma Research Group. This first episode covers a lot of ground, from a detailed discussion of the procedure itself to a thorough exploration of a recent paper contrasting the efficacy of traditional chest tubes against pigtail catheters.  Dr. Stuart calls out a couple important pearls, notably that oxygenation status is a very late finding for tension hemo/pneumothorax, and separately, that breath sounds are unreliable in determining whether a patient has this type of injury. A recent paper gets some attention in this episode, and really illustrates why it's important to dig deeper than the abstract and conclusion:  Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813. You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com. Have a listen and let us know what you think!

We all learned it. We've all done it. And we (mostly) all know that it's wrong. Dr. Seth Collings Hawkins joins Trevor and Claire to discuss spinal immobilization. Rigid immobilization of trauma patients is entrenched dogma, but we've probably all heard that this procedure is not just without benefit, but is in fact harmful to our patients. Dr. Collings Hawkins is a leader in the wilderness EMS community, and he breaks down the reality of spinal immobilization and how we can all do better. Listen up as he talks about the history of this intervention, discusses appropriate uses for the rigid backboard and c-collar, and then shows how we can do better. This is important information for everyone to hear, from new medics to experienced flight surgeons. Have a listen and let us know what you think!

Captain Madison Anderson, RN, joins Claire and Morgan to discuss the pre-hospital care of sexual assault victims (SMOG SPECIAL POP V). It's a difficult topic, but it is critical for flight medics to understand the specialized care this patient population requires. CPT Anderson is a Sexual Assault Medical Forensic Examiner (SAMFE), and she makes important points about balancing patient care protocols with the need to minimize disturbing the victim. She also speaks extensively about the continuum of care for sexual assault victims, and gives important context to where pre-hospital care fits into a victim's path to healing. CPT Anderson frequently refers to MEDCOM Regulation 40-36, Medical Facility Management of Sexual Assault, which is available with a CAC at the Army's Office of the Surgeon General MEDCOM Publications Portal. Take the time to listen to this important conversation, and let us know what you think!

Lt. Col. Joe Maddry joins Max and Morgan to talk about SMOG Medical XIX, Toxic Ingestions. Toxicology is extraordinarily complex, and this discussion ranges beyond ingestions. Dr. Maddry is an emergency medicine physician and has completed a toxicology fellowship. Listen up as he breaks down initial treatment for a range of emergencies from reptile bites to rocket fuel inhalation to intentional overdose. Dr. Maddry is the Deputy Commander of the Walter Reed Army Institute of Research and is extensively published on a variety of topics, with much of his research devoted to pre-hospital and enroute care. If you don't have an account through the AMEDD Virtual Library yet, check out this article from nextgenerationcombatmedic.com on how to get access to the medical journals where Dr. Maddry and others publish their important research. And while there is not a poison control center exclusively for the military, all of the domestic poison control centers communicate with each other and can get you help with treating poisoned patients. Keep 1-800-222-1222 in your phone! And whether you're at home or deployed, you're not alone when you're trying to treat a complex toxic emergency. If you need a consult, call the DOD Advanced Virtual Support for Operational Forces program, or ADVISOR: 1-833-ADVSRLN (1-833-238-7756 or DSN 312-429-9089).

New Zealand Army Nursing Officer Captain Buffy Little joins Max and Trevor to talk about her service's rotary-wing MEDEVAC program. New Zealand is one of our closest allies, but their Army's small size and remote geography mean their operations are dramatically different from ours. Listen up for interesting differences in how they equip and crew their aircraft, as well as major differences in their pre-hospital training and certification levels. Captain Little is an inspiration. She's deployed with the New Zealand Army, beat cancer twice, and was one of the first rescuers on scene of the 2019 White Island volcano eruption. Now she's training to compete in the Invictus Games, and is a founding member of Kaitiaki Ora—Tactical Medicine New Zealand.  Have a listen and let us know what you think!

This is a packed episode from one of the leaders in our field! Doc Rush joins us again to talk about traumatic brain injury, head injury, and why those two are not the same.  Listen closely as Doc Rush boils down this complex topic to its essentials. First he hits on the three main causes of altered mental status in trauma: Hypoxemia from chest injuryHypoperfusion from hemorrhageA blow or jolt to headNext, he discusses the mortality associated with status epileptics, usually defined as a seizure that lasts longer than five minutes, or having more than one seizure within a five minute period, without returning to a normal level of consciousness between episodes. Doc discusses an article he co-authored about TBI and hypertonic saline in the last JSOM: DeSoucy, E. S., Cacic, K., Staak, B. P., Petersen, C. D., van Wyck, D., Rajajee, V., ... & Rush, S. C. (2021). 23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals, 21(2), 25-28.And some final points: Note the subtle but important difference he recommends for target ETCO2 in TBI patients, and why—there is a difference in the values between blood gas and end-tidal. Make sure you're subscribed to @pjmedicine on Instagram, and that you're listening to PJ Medcast!

Chief of the Joint Trauma System Colonel Stacy Shackelford joins Max and Claire to talk about the history, mission, and future vision for the organization singularly focused on reducing morbidity and mortality on the battlefield. During this wide-ranging discussion, Dr. Shackelford describes JTS initiatives directly relevant to our role in rotary-wing MEDEVAC. She also specifically mentions resources available on the JTS website, including Clinical Practice Guidelines, the Deployed Medicine app, and how to get access to the JTS' Thursday calls. Go to jts.amedd.army.mil or our show's website for more information. This is a great discussion with the leader of a pioneering entity dedicated to the most acute aspect of our role as flight medics. Take a listen, and we welcome your feedback!