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Kevin is a nurse anesthetist with more than a decade of bedside nursing. Dennis brings him on to talk about the part of prolonged field care that the CPG describes but does not time: nursing care. The conversation starts with a practical definition. Life-saving interventions finish, and the patient is stabilized. That is when nursing begins. In a hospital, this is the handoff to the floor, PACU, or ICU. In the field, it is the moment after the tourniquet is converted, the amputation is complete, or the chest tube is in, and you are no longer chasing the next immediate threat. From there, Kevin walks through what nurses actually do: continuous assessment and vital signs, documentation that keeps the provider from flying blind, pulmonary toileting, turning, skin care, dressing changes, medication administration, and monitoring every tube and line that has been placed. All of it is time-consuming. Training advice is blunt. Mannequins do not show you the standard. Weekend ICU shifts do. You need to know what right looks like before the field degrades it. Evacuation remains the primary plan. Prolonged field care is the emergency option in the PACE plan, not the default. Kevin points to Desperate Surgery in the South Pacific and the simple observation that every platform that brought troops forward also brought them back. History already solved versions of the time problem. The risk is treating patients as expectant who are not, then letting the absence of basic nursing care finish them before they reach a surgeon. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Nursing starts when life-saving stops. Once the patient is stabilized and you are no longer performing immediate interventions, nursing care begins. That is the practical handoff point in the field.Data gathering is the foundation. Assessment, vital signs, neuro checks, and documentation of every tube, dressing, and intervention are what let a provider manage the patient. Without it the provider is blind.The majority of prolonged field care is nursing. Turning, pulmonary toileting, skin care, dressing changes, medication administration, and line care are the work. They are also the first things dropped when patient numbers rise.Train against a known standard. Weekend ICU shifts show you what right looks like. Mannequins do not. You will degrade in the field; you need to know what you are degrading from.Evacuation is still the primary plan. Treat prolonged field care as the E in the PACE plan. History (South Pacific, WWII) already solved versions of the time problem. Do not label patients expectant and withhold basic nursing care unless the injury is clearly unsurvivable. Chapters 02:10 When does prolonged field care nursing start?03:59 After life-saving interventions: the handoff point04:29 What nurses actually do: assessment and data gathering06:47 Interventions: turning, pulmonary toileting, skin care, lines07:30 How to train it: know the standard before the field degrades it08:17 Weekend ICU shifts beat mannequins10:48 Prioritizing when you are solo12:00 Assessment frequency and catching change early24:00 Sedation, movement, and the unstable patient28:00 IV and line care in the field32:00 Cleaning and dressing sites with limited supplies40:00 Calling the provider and the cost of interruptions44:00 Perfusion and the trauma patient54:40 Evacuation as the P in the PACE plan55:08 The time math: one ICU nurse versus twenty patients57:00 Prolonged field care as the emergency option58:20 GWOT spoiled us on rapid evacuation59:12 Desperate Surgery in the South Pacific01:00:01 How they moved casualties without air superiority01:02:35 Expectant category and not withholding nursing care01:04:15 Low-titer whole blood and learning from history

We covered the new analgesia guidelines from TCCC, now lets talk about how to get it done. Ryan Knight — emergency physician and Deep, Army anesthesiologist now at UNC, walk the new battlefield analgesia list. Ryan’s views are his. Not the committee’s What is on the card: acetaminophen, meloxicam, suzetrigine, ketamine, S-ketamine. Can you treat a combat wound with that? Both say yes — because ketamine is versatile and APAP plus a COX-2 actually work on traumatic pain. Suzetrigine is the unknown. Published data is bunionectomies and abdominoplasties. Onset is about two hours. Nobody in this room has used it on the X. Ketamine is the bridge. Dennis asks the medic question: ketamine is almost harmless, so why not just repeat 25 mg IV or 100 mg IM until the pain stops? Deep’s answer is toxicology. The dose makes the toxin. Escalate and you lose the airway reflexes that made ketamine feel safe. Secretions plus an irritant is the laryngospasm pathway. Ketamine is a direct myocardial depressant; catechol-depleted, bleeding, hypoxic patients do not get the usual bump. Shock liver and hypothermia mean you metabolize less and clear norketamine slower — same milligrams, longer and harder effect. A stable high-pain patient may need stacked doses. A wrecked one may need 5–10 mg at a time. Guidelines try to arm you at the edge of your skill and still survive a draw-up error. Training reps and real clinical time build better guardrails than a thinner formulary. Top 5 takeaways You can run analgesia on the new card — ketamine does the real work. APAP + a COX-2 cover some traumatic pain. Suzetrigine is unproven in combat and slow (~2 hours, elective-surgery data). Do not plan the first 30 minutes around it.Ketamine is not a free refill. 25 mg IV / 100 mg IM is a start. Stacking in a stable, high-pain patient is expected. The same printed dose in hemorrhage, hypoxia, hypothermia, or shock lasts longer and hits harder.High-dose ketamine loses the features that made it “safe.” Airway reflexes blunt. Secretions rise. Laryngospasm is uncommon, not imaginary. Direct myocardial depression shows up when catechol reserve is gone. Dysphoria used to have midazolam. That tool is off the guideline.Opioids left more because of the market than a vote. OTFC and Dsuvia/sufentanil products went away. A lozenge is hard to 4×. A syringe is not. They remain the literature’s breakthrough-pain standard. Acute addiction is the director’s problem; respiratory depression is the medic’s.Best care and safest care are both the job. Directors backstop with logistics (1 mg vs 5 mg hydromorphone) and fight for calendar time. Senior medics own reps. Deep: high-fidelity / real clinical time builds better guardrails than a protocol written by people who no longer push the drug.Chapters 01:59 New analgesia card: suzetrigine, S-ketamine, more removed than added02:46 Can you treat a combat wound with APAP, meloxicam, suzetrigine, ketamine, S-ketamine?03:38 Suzetrigine: bunion/abdominoplasty data, ~2-hour onset04:10 Deep: untested drugs, ketamine side-effect kit, midazolam gone05:13 Opioids as context-specific adjunct, one-iteration concern06:06 French prehospital RCT — ketamine non-inferior to morphine, less nausea09:15 Stable high-pain vs bleeding/hypoxic — same printed dose, different patient11:04 Norketamine, shock liver, hypothermia — same milligrams, longer hit12:04 Ryan: the catastrophic effects are rare — context still matters44:11 Breakthrough pain in the literature is still an opioid45:18 Is addiction the medic’s problem on the X?47:14 Side effects and hemodynamics, not just addiction47:38 The market removed OTFC and Dsuvia49:34 Are guidelines best care or safest care?51:06 Ryan as 75th / XVIII Airborne medical director — arm them, backstop the mistake53:21 Training reps beyond Table VIII / SOCM / 18D refreshers54:33 Deep: guardrails come from training and real clinical time

Recorded live at SOMA 26 Dr. Sam, an orthopedic and surgical oncologist, shares hard-won lessons from humanitarian deployments in Syria, Ukraine, and Gaza. Operating in underground basements under airstrikes, he describes mass-casualty events that overwhelm capacity (hundreds arriving at once, patients dying on the doorstep), the deliberate targeting of marked hospitals and medical personnel, and the practical realities of war surgery when blood, space, evacuation, and supplies are exhausted. Core messages include leaving high-energy extremity wounds open, the decisive role of blood logistics over pure surgical skill, the impossibility of saving everyone in true MASCALs, and the long-term weight of moral injury for both patients and providers. Sponsored by the Special Operations Medical Association. Takeaways Marked medical facilities and personnel are targets. Hospitals in Syria were driven underground; killing a medic or destroying an ambulance removes a community’s capacity for hope and future care.Leave war wounds open. High-energy blast and missile injuries continue to declare dead muscle for days; closing too early traps infection. Wait for a cleaner environment before definitive closure.Logistics (especially blood) save more lives than technical skill alone. Arbitrary quotas, unreliable cold chains, and no ability to escalate care render even correct triage useless.True MASCALs (dozens to a hundred patients) force binary decisions: choosing one patient means another dies. You cannot save everyone; the goal is to train so you do it wrong less often.War surgery is technically straightforward (debridement, amputation, fasciotomy, crash thoracotomy) but operationally and psychologically extreme: hostile environment, no gloves/gowns/evacuation, 20-hour days, and constant moral injury.Psychological resilience has no universal protocol. Many providers function while deployed and struggle afterward; moral injury (watching children die, body-bagging patients in cartoon pajamas, colleagues losing entire families) requires deliberate preparation and recovery. Chapters 00:00 – Introduction and controlled vs. humanitarian environments01:50 – Purpose of the talk: war does not discriminate02:30 – Medical facilities as targets (Syria, Ukraine, Gaza)04:00 – Underground hospitals and mass-casualty realities in East Aleppo06:40 – War surgery is technically simple; the environment and psychology make it hard07:10 – Leave war wounds open: case progression and rationale08:30 – You cannot save everyone: triage under extreme resource limits09:10 – Chaos of body bags and declaring the dead10:00 – Blood protocols, logistics, and the limits of escalation20:50 – Case examples: blood quotas, open fractures, and failed resuscitations22:00 – Moral injury in the OR and among local staff23:00 – Starvation, maggots, compartment syndrome, and unhealable psychic scars24:30 – Providers as casualties: double-taps and personal losses25:20 – Scenes from Gaza: resource decisions and morgue realities27:20 – Final take-home points and psychological resilience29:00 – Why the work matters and closing remarks Listen / follow: podcast → prolongedfieldcare.org → @prolonged_field_care

A healthy person lying in the snow at -30 or -40 dies of hypothermia. Add a gunshot wound, wet clothes, and twenty minutes on the X while the team finishes the fight, and the cold competes with the bleeding. Thomas spent nine years as a Danish Special Forces operator and medic. His view is that TCCC still applies, but the sequence does not survive contact with that climate unchanged. Stripping a chest or abdomen to “do MARCH” on the snow makes the patient colder, more coagulopathic, and more acidotic. Massive hemorrhage still gets a tourniquet, over the clothing, because it is fast. Airway obstruction gets a roll to prone. Everything else waits for a semi-controlled heated shelter. That shelter is not a rock. It is a tent, a stove, and enough security to put both up. Clothing changes the tools. A CAT may not reach a thigh under five layers. Mittens make the windlass clumsy, and taking them off at these temperatures is a frostbite problem in minutes. Train with the gloves you will wear. Inside the tent, two multi-fuel burners on a stable platform, a vapor barrier, and active heat come before a full secondary survey. Drugs he keeps close: ketamine, morphine, prefilled syringes rather than ampules, and an IV antibiotic. Plastic IV bags leak and contaminate when they thaw. Crystalloid and albumin in glass survive better. Blood products are still plastic. Freeze-dried plasma can work, but it needs fluid and time. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Hypothermia is a whole-team threat, and it outruns a lot of procedures. At these temperatures a down patient, especially a bleeding one, does not have a normal MARCH window on open snow.Tourniquet over the clothing. Then get to heat. Do not strip chest or abdomen on the X. Airway obstruction gets prone positioning. Tactical field care starts in a heated, semi-controlled shelter, not behind a rock.Gloves stay on. Test the tourniquet on the real clothing. Layer bulk can force a second tourniquet. Bare hands at minus forty are a frostbite injury in minutes. Practice the application you will actually do.Cold kills the kit. Batteries die. Plastic IV bags leak when they thaw. Prefer glass vials and glass crystalloid. Freeze-dried plasma is possible if you have fluid and minutes. Prefilled syringes beat ampules with numb fingers.The first shelter is a planning problem, not a terrain feature. You need time and security to pitch a tent and light a stove. Ten minutes down at minus twenty-five was enough to drop consciousness in a non-trauma patient. Wool, a stove you can start in mittens, and a tent you can pitch fast are medical equipment.Chapters 00:19 Thomas — Danish SOF medic, anesthesiologist, Brightbird, Greenland03:03 How extreme cold changes TCCC06:08 Hypothermia plus injury, frozen fluids, dead batteries06:43 Treatment on the snow makes him colder, coagulopathic, acidotic07:55 Hypothermia is patient care and a team threat08:16 Tactical field care waits for a heated shelter08:48 MARCH on the X: hemorrhage first, clothing in the way12:03 Do not start full MARCH until the environment is semi-controlled14:01 Tourniquet over the clothing, prone if the airway is obstructed22:00 Vapor barrier first, stop further heat loss24:00 Tent up, stove running, then the secondary work28:00 Warming drugs against the body32:00 Cold drugs and product degradation36:00 What cold does to the kit outside37:27 Ketamine, morphine, prefilled syringes, IV antibiotics38:11 Plastic IV bags leak on thaw. Glass crystalloid. Blood is still plastic.38:46 Freeze-dried plasma: possible, needs fluid and time39:26 How far to the first shelter41:21 A tent needs security. Thirty minutes is already long.43:07 Greenland expedition: ten minutes down, consciousness dropping, no new injury45:39 Wool, tested gear, stoves you can light in gloves49:11 Warm at all costs. Hemorrhage because it is fast.49:38 Afghanistan heat versus minus forty

Medics add interventions easily. Prolonged field care is where those interventions start charging rent. Dave walks the unwind. A cut endotracheal tube used as a cric can come out if the patient no longer needs it. Unhook the bag. Moving air through the tube, following commands, and a normal breathing pattern are good signs. Cuff down: if he cannot breathe around it, edema or a flap may be waiting, and pulling can lose the airway. Suction above the cuff first. Dress the site after. Do not pull the bookmark on a partial responder still in shock just to save narcotic. Uncomfortable and awake beats a lost airway. Chest-tube logic is the same. Serous output and stable oxygen are a pull conversation. Blood, pus, or a leak plus climbing crepitus means the tube stays. Heimlich is enough for many. Suction, if used, is about 20 cm of water — a straw, not wall suction. No underwater seal is a sucking chest wound you created. A chest wall you cannot seal is bagged. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift the patient you were trying to save. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways A cric can come out if the patient no longer needs it. Positive pressure off, breathing through the tube, follows commands, normal pattern, cuff down and air moving around the tube. Fail that last test and you may be looking at edema or a flap.Suction before you drop the cuff. Dress after you pull. Whatever is sitting on the balloon goes into the lungs. Occlude the site for cough and speech. If he obstructs again, adjuncts first, then back in.Do not trade the airway bookmark for narcotic savings in a partial responder. Shock patients who drop their GCS after you pull are a different problem than the isolated femur you over-sedated. Uncomfortable and awake beats lost airway.Chest tube suction is 20 cm of water, not wall suction. Heimlich is enough for many. Serous and stable oxygen is a pull conversation. Blood, pus, or a kazoo plus climbing crepitus means the tube stays. No seal equals a sucking chest wound you created.Some interventions you should not start if you cannot finish them. An unsealable chest wall is bagged, not endlessly patched. A continuous leak with crepitus is surgical. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift a patient you were trying to save. Chapters 01:17 Adding interventions is easy. Unwinding them is the PFC problem.02:17 The oversedated femur: ketamine, narcotic, snoring, cric03:46 Same patient in a trauma bay — RSI, then do they still need the tube?05:19 Yes, you can pull a cric — if the airway is not the problem you are about to recreate06:29 Off the bag, follows commands, breathing pattern07:10 Cuff down: can he breathe around it?09:01 Suction above the cuff before you deflate09:42 Ketamine no-man’s-land between analgesia and sedation10:41 Fentanyl for the cuff, not another snow14:05 If the airway is quiet, leave it until everything else is mitigated14:16 Do not pull the bookmark in a partial responder28:07 What is coming out — serous vs blood vs pus28:30 Empyema tubes that stay for months28:33 Air leak on a Heimlich: kazoo is fine, crepitus is not29:02 SpO2, mental status, oxygen need before a pull29:37 Heimlich vs three-bottle suction30:51 Improvised single-bottle underwater seal31:16 No seal, and you just made a sucking chest wound33:34 Chest wall you cannot seal: positive pressure, or a cric35:41 Finger thor converts tension to open. The tube is a valve and a measuring cup.37:36 Continuous air leak and climbing crepitus — second tube, surgical problem39:25 Sudden crepitus with an advanced airway: dislodged cric vs tracheobronchial injury42:11 Fasciotomy: indication vs the wound you cannot dress

Medics add interventions easily. Prolonged field care is where those interventions start charging rent. Dave walks the unwind. A cut endotracheal tube used as a cric can come out if the patient no longer needs it. Unhook the bag. Moving air through the tube, following commands, and a normal breathing pattern are good signs. Cuff down: if he cannot breathe around it, edema or a flap may be waiting, and pulling can lose the airway. Suction above the cuff first. Dress the site after. Do not pull the bookmark on a partial responder still in shock just to save narcotic. Uncomfortable and awake beats a lost airway. Chest-tube logic is the same. Serous output and stable oxygen are a pull conversation. Blood, pus, or a leak plus climbing crepitus means the tube stays. Heimlich is enough for many. Suction, if used, is about 20 cm of water — a straw, not wall suction. No underwater seal is a sucking chest wound you created. A chest wall you cannot seal is bagged. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift the patient you were trying to save. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways A cric can come out if the patient no longer needs it. Positive pressure off, breathing through the tube, follows commands, normal pattern, cuff down and air moving around the tube. Fail that last test and you may be looking at edema or a flap.Suction before you drop the cuff. Dress after you pull. Whatever is sitting on the balloon goes into the lungs. Occlude the site for cough and speech. If he obstructs again, adjuncts first, then back in.Do not trade the airway bookmark for narcotic savings in a partial responder. Shock patients who drop their GCS after you pull are a different problem than the isolated femur you over-sedated. Uncomfortable and awake beats lost airway.Chest tube suction is 20 cm of water, not wall suction. Heimlich is enough for many. Serous and stable oxygen is a pull conversation. Blood, pus, or a kazoo plus climbing crepitus means the tube stays. No seal equals a sucking chest wound you created.Some interventions you should not start if you cannot finish them. An unsealable chest wall is bagged, not endlessly patched. A continuous leak with crepitus is surgical. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift a patient you were trying to save. Chapters 01:17 Adding interventions is easy. Unwinding them is the PFC problem.02:17 The oversedated femur: ketamine, narcotic, snoring, cric03:46 Same patient in a trauma bay — RSI, then do they still need the tube?05:19 Yes, you can pull a cric — if the airway is not the problem you are about to recreate06:29 Off the bag, follows commands, breathing pattern07:10 Cuff down: can he breathe around it?09:01 Suction above the cuff before you deflate09:42 Ketamine no-man’s-land between analgesia and sedation10:41 Fentanyl for the cuff, not another snow14:05 If the airway is quiet, leave it until everything else is mitigated14:16 Do not pull the bookmark in a partial responder28:07 What is coming out — serous vs blood vs pus28:30 Empyema tubes that stay for months28:33 Air leak on a Heimlich: kazoo is fine, crepitus is not29:02 SpO2, mental status, oxygen need before a pull29:37 Heimlich vs three-bottle suction30:51 Improvised single-bottle underwater seal31:16 No seal, and you just made a sucking chest wound33:34 Chest wall you cannot seal: positive pressure, or a cric35:41 Finger thor converts tension to open. The tube is a valve and a measuring cup.37:36 Continuous air leak and climbing crepitus — second tube, surgical problem39:25 Sudden crepitus with an advanced airway: dislodged cric vs tracheobronchial injury42:11 Fasciotomy: indication vs the wound you cannot dress

The internet will tell you how to “win” a VA claim. Almost none of it is how the exam is actually written. Will spent 11 years Navy EOD, 9 as a SOF medic, and now sits as a National Guard battalion PA. In the middle he worked the other side of the table: third-party C&P exams. Meet the veteran. Fill the cookie-cutter form. Ship it to the VA actuaries. He never got Genesis. He got whatever dump the system decided was fit to send — problem lists, notes, radiology reports, and every PHA where you checked “no” to stay deployable. What the examiner is hunting: a diagnosis, a nexus event, and a physical that matches the story. Range of motion. Special tests. Flare-ups. Work. ADLs. If they only asked questions and never touched you, that exam is incomplete. Say so. SOF and aviation make this worse on purpose. Pipelines punish honesty. Team medics hand out diclofenac and toradol and skip the note so the guy keeps special duty pay. That is loyalty on Friday and a missing nexus on the way out. Will’s practical kit: be honest on the late-career PHA. Print the DD-214s, V-device awards, schools, and the pages that prove exposure — because the current MOS on the screen may say PA while the tinnitus came from being an 18D. You have 10–15 minutes per condition. Do not make them scroll 2,000 pages. Read 38 U.S.C. § 1155. Use VA.gov. Ask the teammates who already finished the process. prolongedfieldcare.org | @prolonged_field_care | PFC Podcast Top 5 takeaways The examiner is not in your EHR. They get a curated PDF. If the note, x-ray report, or PHA is not in that dump, it does not exist that day unless you hand it to them.Late-career PHAs are evidence. Battalion medicine may ignore them. The VA file does not. Stop auto-checking “no.”Nexus plus diagnosis plus a matching physical. No in-service diagnosis makes the hill steeper. “Audio has to match the video” — a perfect straight-leg raise after a “debilitating” claim is a problem.SOF culture writes the denial years early. Off-book gel and ketorolac keep people on the team and delete the paper trail. The C&P form cannot rate what was never documented.Run the exam like a 15-minute hit. Tab DD-214s, awards, schools, and the pages for this appointment. Current MOS can hide prior blast and gunship time. C&P staff are QTC/Leidos contractors, not VA raters.Chapters 00:21 Will: EOD, SOF medic, Guard battalion PA01:03 Third-party VA examiner — what the job actually was02:05 38 U.S.C. § 1155, Reddit, do the homework03:03 Active duty TAP vs Guard/Reserve fog03:33 Guard can file after first enlistment — and drill at 100% with offset04:13 What the evaluator actually reads04:40 No Genesis. You get the dump they send.05:17 Those “no” PHAs are in the file05:52 Cookie-cutter exams, history, nexus, physical06:45 If they never laid hands on you, the exam is incomplete07:30 Be your own advocate — diagnosis first08:18 SOF and pilots under-report to stay in the pipeline09:11 Off-book team medicine: gel, toradol, no note10:00 Confirm the injury, grade the injury10:34 Audio has to match the video31:07 “I’m fine” is not the same as pre-service baseline31:51 Examiner is not your enemy and not your lawyer32:17 10–15 minutes per condition — they will leave value on the table33:06 1,500–3,000 page PDF. Awards and 214s get buried.33:44 Build the packet: 214s, V-device awards, schools, EIB34:54 Print the pages for this exam so they stop scrolling35:56 Current MOS can hide prior SOF noise and blast37:27 Where to go: the Code, VA.gov — who to skip: paid mills39:16 C&P is QTC / Leidos. They cannot reach into a record you do not bring.40:45 Close: it matters for the family Listen before you walk into the C&P This is education from one former examiner, not legal advice and not a how-to for inflating a claim. Use VA.gov and a VSO for the filing itself.

Most of us were taught START, the sieve, RAMP, DIME, P1–P3. Andrew — EM physician on a small surgical team out of Fort Liberty — used none of it the night a helicopter went down with 22 people on board. The rest of his medical team could not walk. Dust, firelight, yelling. Thirty-to-sixty seconds per patient on a linear algorithm is ten minutes before you reach number ten. People die of massive hemorrhage and lost airway in that window. So he ran a binary pass: dying now or not. Blood sweep. “Take a deep breath.” Pulse. Ten to fifteen seconds. Keep a mental list of who leaves first. He got through about twelve before other medics arrived. He never reached the massive bleeder — a non-medic first responder did. That is the point. Rick Hines puts the doctrine next to the wreckage. Triage is continuous, not a one-and-done sort. The most senior medical person is often the worst person to own the sort if they should be operating. Algorithms used after the first pass are training tools — studies put accuracy around or under 50 percent. Training has to match that. Four casualties before twenty-two. Global endpoints, not a perfect score on every manikin. Delayed birds. Command decisions. Unit buy-in, not a tourniquet-and-check-the-block. No perfect MASCAL. You were already behind when it started. Listen: PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Top 5 takeaways First contact is binary. Dying now / not dying now. Blood sweep, air movement, pulse. 10–15 seconds. Do not spend a minute running START on patient one while patient ten bleeds out.Then deliberate triage. After LSIs and a move to the CCP: urgent / priority / routine (what TCCC/CoTCCC are leaning toward). Expectant exists when resources force it — not on the first pass.Move, treat, transport. Rush’s three verbs beat a four-color card at the wreck. Get off the X, stop hemorrhage and airway loss, get them to the next level.The senior clinician should not automatically own the sort. If they are the surgeon, someone else runs triage. Non-medic first responders are part of the system — Andrew never reached the massive hemorrhage; someone else did.Train the real constraints. Nail four before you role-play twenty-two. Score the lane on whether life threats were found, blood got to shock, accountability held, and evac was prioritized — not whether every individual critical-action list was perfect. Delay the bird. Make the commander choose.Chapters 00:00 Disclaimer and welcome00:20 Andrew Shafrina intro — EM, small surgical team, Fort Liberty01:23 Why most of us never actually practiced triage02:14 Categories: START, sieve, NATO — four bins plus expectant04:10 Why linear algorithms are too slow at the point of injury04:32 The crash: 22 onboard, medical team down, one provider05:39 The 10–15 second pass — blood sweep, deep breath, pulse06:09 Rush, Shackelford, Remley, Hines — binary is what people actually do06:50 Move, treat, transport08:07 What “stable” meant that night — not P1/P2/P308:51 Twelve patients in five minutes — and he still missed the bleeder10:01 Triage is continuous, not one-and-done10:36 Do not burn the surgeon on the sort11:11 MASCAL means you are already overwhelmed12:06 Put non-medics to work12:43 Evac categories vs who actually needs an OR13:45 First-pass binary, then UPR at the CCP14:14 Algorithms as training tools — accuracy ~50% or worse47:06 Train to global endpoints, not perfect individual checklists48:08 Can you handle four? Then scale.49:09 Rick: six dead, seventeen wounded, no bird, they drove them out52:23 King for a day: two-phase triage + basics53:50 There is no right way — only best with what you have54:18 Put MASCAL inside unit drills, not isolated medic lanes55:22 Scare the staff honestly — risk, delayed evac, command decisions

Dennis sits down with Max to walk through hemorrhagic shock the way it actually behaves in young, healthy military-age casualties—not the tidy textbook ladder of Class I–IV. They start with the only split that matters: compensated versus uncompensated. Class I–II means the body is still delivering oxygen to organs. Class III–IV means it is not, and the damage is no longer a simple volume problem. Max breaks compensation into “gears”: venous reserve first (no vital-sign change), then heart rate, pulse-pressure narrowing from arterial squeeze, contractility, and work of breathing. He stresses why a 40-year-old operator with a resting HR of 50 who hits 80 is already tachycardic, why a diastolic climbing toward 100 is a warning, and why scene blood volume—“How much blood was on the ground?”—is often the most important sentence in the handoff. They cover why fit casualties can look like Class II, then skip Class III and drop into unconscious Class IV in minutes (Ranger Campbell and similar “walking dead” cases). Decision-making is reduced to two tenets: Is bleeding stopped? What is the trend? Guidelines that wait for SBP 100 will be late in this population. Short pearls close the episode on peds (small volumes, parental mental-status baseline), pregnant patients (left-side IVC, massive reserve then sudden collapse), and elderly (they follow the book but cannot tolerate Class III). Top 5 takeaways Draw the line between compensated and uncompensated, not between the four classes. Once end-organ perfusion fails, you are not just replacing lost volume—you are treating ischemia, cytokines, electrolyte leak, and reperfusion.Trauma tachycardia is hemorrhage until proven otherwise. Pain, exertion, and combat stress are real, but you do not get to invoke them until you have ruled out bleeding.Pulse pressure and diastolic BP are early windows into how hard the patient is squeezing. A young casualty at 120/100 with a climbing HR and changing affect is already near the cliff even if SBP is still “fine.”Fit operators can stay in Class II on exam until they have lost a lethal volume, then skip Class III. Reassess constantly. Scene blood volume and expanding hematomas matter more than a single SBP number.Two questions drive transfusion in resource-limited care: Do I have hemorrhage control? Is the patient trending the wrong way on two or more data points (HR, pulse pressure, breathing quality, mental status, hematoma size)? One number on a guideline is not a plan.Chapters 00:00 — Intro and disclaimer00:20 — What we’re covering: hemorrhagic shock and when to resuscitate01:12 — Traditional Class I–IV and why textbooks fail in the field03:00 — Compensated vs uncompensated: the only line that matters04:50 — Class I: venous reserve, no vital-sign change08:30 — How much blood was on scene? The handoff question that predicts danger11:15 — Tennis-score memory aid (15 / 30 / 40) and Class I exam16:20 — Operator baselines: HR 80 can already be tachycardia20:00 — Golden rule: trauma tachycardia is bleeding until proven otherwise22:00 — Pulse locations as a crude MAP map (carotid / femoral / radial)27:00 — Why SBP stays normal in compensated shock29:00 — Pulse pressure explained: diastolic rise, not “falling BP”36:00 — Compensation gears: reserve → HR → squeeze → contractility → breathing39:00 — Orthostasis, cap refill, urine output, and mental status as red flags47:00 — Altered mental status: “drunk” from blood loss until proven otherwise51:00 — Class II: all gears on, BP still held59:00 — Class III–IV and why healthy patients blast through Class III1:06:50 — Ranger Campbell and other “walking dead” cases1:11:48 — When to give blood if SBP is still over 1001:13:50 — Tenet 1: Is bleeding stopped? Five spaces that hide volume1:20:40 — Tenet 2: Trend, not a single trigger1:27:50 — Don’t hang a life on one guideline number1:32:40 — Pearls: pediatrics, pregnancy (left side / IVC), elderly

Ben walks Dennis through a six-month plan that became a jungle course for about 200 unpaid resistance volunteers. Vic built the curriculum from TCCC, the Ranger Medic Handbook, and what that force actually needed — then wrote it to their education level, culture, and organization. Supplies moved through the existing network. The first four days were not student training. They were instructor train-up. Then the locals taught. Interpreters shrank. Force multiplication went up. Chiefs owned the schedule because they knew the logistics better than the foreigners. The five-day basic block — Ranger First Responder flavor, ~150 students, three languages — ran cleaner than the ten-day advanced course. Around day six, the instructors sat in a hut wondering if anyone could action the material. The FTX answered it: recovery mission, collect, treat, triage, evacuate. When words failed, Ben inserted himself into the lane. Watch me. Do as I do. Then the punchline he brought home to NATO partners in four and a half days: stop making this more complicated than the environment allows. Basics save lives. Teaching is a hard skill and a soft skill. Ego gets you ignored — or worse. Likability moves supplies. Medics still have to influence commanders so casualties do not bog down the assault. Listen, then steal the method. Not the ego. ⁠prolongedfieldcare.org⁠ | ⁠@prolonged_field_care⁠ | PFC Podcast Top 5 takeaways: Build a local instructor cadre first. Four days of train-the-trainer, then hand the blocks to them. Less interpreter drag. Real force multiplication.Write the course to the force in front of you. TCCC + Ranger Medic Handbook as the spine. Education level, culture, and org constraints as the cut line. Chiefs own the schedule.Basics scale. Abstraction does not. The 5-day / 150-student / 3-language block worked because it was see-do-act. The 10-day advanced block created the “do they actually get this?” crisis.When comprehension is in doubt, stop talking and enter the lane. Insert yourself. Narrate while you do the work. Show shock. Do not lecture shock.Teaching is an act of love plus influence. Humble competence beats the alpha brief. Medics still owe commanders a clear recommendation — even if the answer is “we’re doing it anyway, figure it out.”Chapters: 00:00 Cold open + why this trip01:08 Six months of planning — you do not show up on a whim01:59 Vic Nigo’s curriculum: TCCC, Ranger Medic Handbook, culture, org02:51 Supply network for ~200 students03:20 Plan vs jungle reality04:01 Four-day instructor train-up and handing the class off04:56 Volunteers, buy-in, and a culture that does not like quitters06:24 Motivation that costs a patch and a thumbs-up07:29 Ukraine militia hunger vs professional-military spoiling08:26 Why train-the-trainer beats you plus an interpreter09:00 What actually broke: hours, land nav, competing requirements09:54 5-day basic / ~150 / 3 languages — the block that worked10:53 10-day advanced — day 6 doubt in the hut11:41 The FTX: recover, collect, treat, triage, evacuate12:30 Teaching tactic: insert yourself, watch me, do as I do13:14 Show them shock. Do not define it.14:13 SOCM lesson: you do not know the job until you see the job34:54 The course continues — Vic takes it deeper / SOCM Light35:37 The West overcomplicates TCCC36:10 Basics save lives37:11 NATO partners in 4.5 days: trenches, physical exam, pain, cheat cards39:17 Advice for the first overseas class40:06 Know the audience — products change with the culture40:39 Ego is a teaching failure and a survival failure41:24 All teaching is an act of love42:03 Likability as a core attribute43:09 The medic as SME: influence, battlefield clearance, buy-in44:56 Be ready for the unexpected — and try to enjoy it

Mike Weisman — 25 years as a Navy Corpsman and SARC, 27 years on a busy Vegas fire department, now clinical education at Celox — does not sell magic dust. He sells a hydraulic problem. A femoral-rate bleed can dump on the order of 500 mL a minute. The clotting cascade is a 14-step masterpiece built for arterioles, not that jet. Early platelet plug gets blown off the vessel wall unless something holds equal pressure against it. Tourniquet, packed gauze, or packed hemostatic gauze: all of them are pressure tools. The chemistry is the advantage on top. Two families, two jobs. Kaolin (Combat Gauze class) is a clay mineral that lights up Factor XII and accelerates your cascade — which means it still needs time and a body that can clot. Chitosan / cellulose dressings work off the cascade. They absorb fluid, grab red cells by charge, and build a viscous mucoadhesive plug. Granules and sprays exist. Mike’s line stays the same: if you do not back them with pressure, you bought a show booth. Then the part schoolhouses skip. The product has to touch the bleeding vessel, not the pool in the hole. Three to six minutes of hold time on a kaolin dressing feels short on the pouch and endless on a screaming casualty. Hemorrhage control is not a monkey skill. Blood programs without packing reps are the cart in front of the horse. Read mechanisms, not company PDFs. Deployed Medicine and independent retrospectives beat the booth. Listen, then pack something that bleeds.prolongedfieldcare.org | @prolonged_field_care | PFC Podcast Top 5 takeaways It is a hydraulic problem. Fight pressure with pressure. Chemistry cannot replace a packed tract or a tourniquet.Know the two mechanisms. Kaolin accelerates Factor XII / your cascade. Chitosan-type polysaccharides work independently and form a mucoadhesive plug.Contact the vessel or you wasted the dressing. Clot in a basin of blood is not hemostasis. Anatomy and packing skill are the product.Hold the clock. Kaolin-class products typically need on the order of 3–6 minutes of continuous pressure. The pouch lie is that this is short.Unconscious competence beats the brand. Schoolhouse reps expire. Blood on the truck does not save the casualty if the medic cannot pack. Understand the mechanism, then pick what your system will actually issue.Chapters 00:00 Cold open00:19 Dennis + Mike (SARC, Vegas FD, Celox education)01:25 Why not just pressure and plain gauze?02:16 Hydraulic problem: cascade vs femoral-rate bleed03:42 What a hemostatic actually adds03:54 Kaolin: Factor XII, still gauze, still pressure04:54 Chitosan / cellulose: cascade-independent mucoadhesive plug06:03 Charge, RBCs, dual action with the gauze07:07 Granules, sprays, “hummus” pastes — still need pressure08:20 No good hemorrhage control without pressure. Period.08:47 Does it have to touch the vessel? Yes.09:34 Anatomy, packing method, skill — not the brand10:07 Why the 3–5 minute hold feels like an hour10:42 Kaolin activation window (~3–6 min)28:57 Know every item in the bag the way you know a drug29:26 You can spot a professional by the pouch30:11 Hemorrhage control is not a monkey skill31:04 Unconscious competence: pack it blind31:56 Blood programs without packing reps33:04 Schoolhouse months do not last a career34:32 How to read studies that are not the company PDF35:37 Deployed Medicine, JTS workload, mechanisms over marketing37:48 Close: keep getting the reps

OTFC is gone. That was not a small supply hiccup. It punched a hole in the old TCCC pain plan. George Barbee, a PA and co-author of TCCC Guideline Change 25-03, walks Dennis through why the committee rebuilt battlefield analgesia instead of patching the old triple-option chart. They screened 56 analgesics. They built an objective matrix. They landed on suzetrigine: non-opioid, mentation-sparing, slow onset, long duration — a drug that can keep a still-fighting casualty in the fight and then carry them into prolonged care. The bigger shift is the fork in the road. Not “mild / moderate / severe” as four overlapping options. Can they stay in the fight, or not? Functioning casualties get a non-sedating pack. Non-functioning casualties get a shock-agnostic pathway so you are not stacking drugs blindly down the continuum. Ketamine is still the drug you reach for when you have almost no information. Nystagmus is not the goal. It is the “you gave too much, back off” line. Option 4 sedation is being pulled out of TCCC and written into PCC, where it belongs. If you still teach OTFC, still dose to shaking eyes, or still treat every casualty like they need a narcotic, this episode is the update. Read the change paper @ ⁠www.prolongedfieldcare.org⁠ or ⁠https://jsomonline.org/⁠ Follow @prolonged_field_care Top 5 takeaways The change was forced. OTFC disappeared, GWOT safety data said the old plan was too loose, and LSCO needs mission-capable pain control plus a safer path for people who cannot stay in the fight.Suzetrigine is the new stay-in-the-fight drug. Non-opioid. Cognition and blood pressure mostly spared. About a 2-hour onset, long duration. Pair it with meloxicam and acetaminophen for the functioning casualty. Muscle spasm in 1–10% is not a seizure and does not get benzos.Stop using four overlapping “options.” Define pain with the Defense and Veterans Pain Rating Scale. Rough cut: 1–6 can often still function and self-declare. 9–10, polytrauma, multi-amp — they are out of the fight. Medics already know this on sight. The guideline finally says it.Ketamine stays, but the endpoint is not nystagmus. If you have almost no information, ketamine is still the safest narcotic start. Reduction of pain means the casualty and the medic can both manage the situation. Nystagmus means you crossed the line. Fixed-dose ketamine in a bleeding patient can get weird as volume drops — not usually lethal, still a problem.Option 4 is leaving TCCC. Heavy sedation and procedural endpoints are being moved into the PCC update. TCCC keeps the systematic, stack-aware, evidence-based path so the next provider is not surprised by what you already gave.Chapters 00:00 — Disclaimer and open 00:23 — Dennis and George: who wrote the change 02:10 — If it ain’t broke, why touch analgesia? 02:56 — We lost OTFC 03:11 — Safety, LSCO, and early pain vs PTSD 04:27 — Mission-capable control and a shock-agnostic path 05:48 — How suzetrigine beat 56 other drugs 09:38 — Why this non-opioid survived the matrix 11:33 — Spasm vs seizure: do not reach for benzos 13:33 — Stay in the fight vs cannot 14:20 — The old “triple option” was actually four 15:06 — Defining pain with the DVPRS 16:10 — The stay-in-the-fight pack: suzetrigine, meloxicam, Tylenol 17:20 — What “reduction of pain” actually means 18:15 — Esketamine: more analgesia, fewer side effects 27:38 — If you only get one narcotic, start ketamine 28:56 — Esketamine, IN 28 mg, and the 4PANE study 30:15 — IV, IO, IM, IN: why they kept the nose 33:07 — Pain control vs nystagmus 35:26 — Option 4 is moving to PCC 36:41 — Chest tubes, crics, and the sedation gap 37:54 — Next: backing the PCC analgesia update 38:48 — Read JSOM Change 25-03 and close

Recorded live at SOMA 26 In a near-peer MASCAL, one medic and one junior medic may face twenty penetrating torso casualties, one unit of blood, and no time to empirically needle or finger-decompress every chest. This SOMA presentation argues that formal triage algorithms are already giving way to intuitive, intervention-first decisions—and that point-of-care ultrasound can make that second pass objective. The proposed two-pass model keeps MARCH as a fast first pass (urgent vs non-urgent), then uses a three-view POCUS exam—parasternal or subxiphoid cardiac motion, pericardial effusion, and bilateral lung apices—completed in under 30 seconds to decide who gets blood, who needs targeted decompression, who needs a surgical airway to thoracotomy or pericardiocentesis, and who is unsurvivable cardiac standstill. Speakers review trauma-arrest survival data, needle-decompression overuse, SOF medic training at Henry Ford (RUSH exam and the abbreviated 30-second protocol), and civilian paramedic programs showing that short courses can produce usable scans that change management. Sponsored by the Special Operations Medical Association. Key Takeaways Empiric bilateral chest decompression and “treat everybody” TCCC habits will not scale in large MASCALs when blood, time, and procedural capacity are scarce.Formal algorithms are often unused in real events; medics already default to intuitive triage. The missing piece is an objective tool that separates salvageable from unsurvivable casualties.Published decompression data show low response rates, high practice variation, and procedures performed on patients who did not meet criteria—driven by subjective breath sounds.Cardiac motion on ultrasound is the strongest practical field marker of salvageability in pulseless trauma; standstill without tamponade is associated with essentially no survival and should conserve blood and procedures.A three-view exam (cardiac motion, pericardial effusion, pneumothorax) can be completed in ~25–30 seconds. SOF medics approached expert performance after focused training; civilian paramedics have shown usable accuracy after 4–8 hour courses.Positive findings should drive action: motion → consider blood; effusion + access to thoracotomy/pericardiocentesis → prioritize evacuation/intervention; no lung slide → targeted decompression rather than bilateral empiric procedures. Chapters 00:00 – Introduction, disclosures, and the MASCAL problem01:00 – Case: 20 casualties, one unit of blood, empiric procedures02:40 – Intuitive triage vs formal algorithms03:20 – Why empiric needle/finger decompression falls short05:10 – Scarce blood and the need for a modified LSCO triage approach05:50 – Two-pass model: MARCH first, POCUS second07:20 – Three-view exam: motion, tamponade, pneumothorax08:00 – Pulseless trauma survival: civilian and military data11:00 – Cardiac views and what “salvageable” looks like15:20 – Field case: ultrasound guiding thoracotomy and blood use16:00 – Can medics do this? SOF RUSH pathway since 201717:30 – Abbreviated 30-second protocol: retrospective and prospective times19:30 – Civilian 4-hour training and New Orleans scan performance22:40 – Putting it together in MASCAL: salvage the survivable24:00 – Resource rules: motion vs standstill vs tamponade25:30 – Questions and close Listen / follow: podcast → ⁠prolongedfieldcare.org⁠ → ⁠@prolonged_field_care⁠

Medical logistics was an afterthought for a lot of us in GWOT. You submitted a request, something showed up, and everyone joked that the warehouse never read the order. That model does not survive large-scale combat operations. In this episode, Dennis sits down with Jesse Bashel, a medical logistician and acquisitionist, to walk through how SOF medical supply is supposed to work—pre-deployment, on deployment, and after the first 15 days. They cover NSNs versus product names, automatic in-lieu substitutions, Theater Lead Agents for Medical Materiel (T-LAM), the shift from OCO “easy button” money to MFP-2 vs MFP-11 rules, statements of requirement, and why most medical items are service-common (GCC problem) while a tiny slice of SOF-peculiar items stay on MFP-11. The conversation then turns practical: MedLog personnel usually have zero clinical training. How do you teach them why a 6.0 tube matters for a surgical airway instead of an 8.5 ET tube? How do you get logisticians into Ridge Healer, unit training, and field exercises so they stop treating the property book as the mission? And why, in LSCO, logistics itself starts looking like a combat MOS—because the side that can feed, fuel, and bandage longer usually wins. If you are an 18 Delta, flight medic, battalion PA, group surgeon, this one is for you. Key takeaways Order by NSN (or full product name + manufacturer), not the nickname you use in the aid bag. Vendors should put NSN placards on tables at SOMA.The system will auto-accept “in-lieu” substitutes unless the logistician blocks it. That is how you get Halo chest seals when you wanted HyFin.SOF units are required to deploy with 15 days of supply. After that, the Geographic Combatant Command (usually MFP-2 / service-common) is supposed to resource the rest; SOCOM MFP-11 covers only SOF-peculiar items (certain CASVAC sets, freeze-dried plasma in some cases, specific antivenoms, etc.).A Statement of Requirements (class I–IX) should be built jointly by the team and the TSOC 180–270 days out when possible, validated by surgeon + J4, then sent to the GCC for a service lead to resource.Most medical products are MFP-2. Do not default everything to “SOCOM will pay.”Close the gap: five-minute education sessions when medics hit the cage, bring logisticians forward on training events, and treat enablers like part of the team instead of a battle squire.In LSCO, supply lines will be targeted. Logistics personnel need to be trained and treated as if they will be on the battlefield—not just in an office. Visit prolongedfieldcare.org, follow @prolonged_field_care, and subscribe so you stay on the bleeding edge of combat medicine. Chapters 02:02 – Pre-deployment ordering done right: NSNs vs product names and why you get the wrong chest seal 04:24 – In-lieu / substitute items and how to stop the system from auto-accepting them 05:24 – Theater Lead Agent for Medical Materiel (T-LAM) catalogs and how they get built 07:09 – MFP-2 (service common / common user) vs MFP-11 (SOF peculiar) 08:27 – Joint pub requirement: SOF deploys with 15 days of supply 10:07 – Who pays for days 16–60? GCC vs US SOCOM headquarters 12:10 – Statement of Requirements process: team + TSOC + GCC J4 validation 15:58 – MedLog has no medical training—how to educate them before they send the wrong tube 21:17 – Closing the operator–logistician distance; policy is not always law 26:00 – Retaining SOF-enabler talent instead of rotating everyone back to conventional force 28:22 – SUBACUS lessons and why enablers must not be a liability forward 30:29 – Two LSCO paradigm shifts: SOF as supporting force + logistics as a combat MOS 32:08 – Positional warfare, endurance, and targeting supply lines (bullets, batteries, bandages) 32:50 – Where to do the work: put a logistician on the DTS for Ridge Healer and big exercises 34:25 – Flip side: teach operators the fiscal and appropriation reality so they can advocate overseas

Ukrainian orthopedic and reconstructive surgeon describes what prolonged field care actually looks like when evacuation from the front line to Role 2 takes three to four days, and sometimes longer. After years of Role 1, Role 2, and evacuation-stage work, he focuses on a problem that now drives limb outcomes: tourniquet syndrome. TCCC made rapid tourniquet application routine; the neglected next step is conversion, replacement, and complication prevention when the casualty remains in the field for hours to days. He shares a three-week Role 1 case series, frontline protocols for resuscitation, antibiotics, and multimodal analgesia, and why communication between echelons is no longer optional. Sponsored by the Special Operations Medical Association. Key Takeaways Combat has outpaced doctrine: drones, delayed evacuation, and shifting surgical capability forward mean medics now make high-stakes decisions that used to wait for the hospital. In summer–autumn 2025, movement from the front line to Role 2 commonly took three to four days. Complications of prolonged tourniquet time develop during that window, not after arrival. Forces have become highly proficient at rapid tourniquet application for hemorrhage control. Far less attention has been paid to when, how, and under what conditions to convert or remove a tourniquet during extended delayed evacuation. Incorrect application, delayed conversion, and early reperfusion errors at Role 1 create complications that later echelons often cannot fully reverse. Prevention at the first capable point is easier than correction later. Over three weeks at one Role 1, the team reviewed 27 tourniquet cases: 18 already removed before arrival, 5 converted on site, 4 replaced, and 8 presenting with established tourniquet syndrome. A tourniquet left on too long can function as a venous tourniquet. In one ~12-hour case, conversion and wound care were possible; the patient still spent a full day at Role 1 because evacuation remained unsafe. Role 1 care in this environment combines hemostatic resuscitation, Ukrainian MoH / JTS-aligned antibiotic prophylaxis, and multimodal analgesia to reduce opioid dependence while waiting for movement. Drones, shelling, and remote mining remain constant threats to both casualties and medical teams. High-quality Role 1 care still depends on continuous risk assessment and tactical awareness. Continuous case review, data capture, and closed-loop communication from prehospital to hospital are essential so frontline observations can change tactics in real time. Chapters 00:00 – Introduction and speaker background 01:50 – Evolving war, prolonged field care, and higher medic responsibility 04:10 – Why tourniquet syndrome now dominates limb outcomes 05:30 – TCCC taught application; the neglected next step is conversion 06:20 – Drones, delayed evacuation, and care shifting pre-evacuation 07:40 – 3–4 day timelines from front line to Role 2 in 2025 08:30 – Role 1 errors that later hospitals cannot fully fix 09:10 – Role 1.5 mission: assess, convert, prevent, stabilize 11:50 – Resuscitation, antibiotic, and multimodal analgesia approach 13:10 – Three-week tourniquet case series (27 TQs, 8 syndromes) 15:00 – Case example: 12-hour venous-effect tourniquet conversion 16:20 – When conversion is no longer possible 17:40 – Ongoing battlefield threats to evacuation and medics 18:30 – Continuous learning and echelon-to-echelon feedback For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠