Prolonged Field Care Podcast

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 ket...

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...

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 c...

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,...

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,...

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...

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 he...

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....

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...

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 ho...

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, s...

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 ob...

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...

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 s...

Antibiotics are not magic. In this episode of the PFC Podcast, Dennis sits down with Ryan to cut through the common myth that “I’ve given antibiotics, so the wound is protected.” They unpack why vigorous wound care—irrigation, debridement of dead tissue, clean dressings, and early surgical washout—remains the foundation of infection prevention in combat and prolonged field care, while antibiotics...

Whole Blood Is Not a Solution (Until Conventional Forces Can Deliver It) Recorded live at SOMA 26 Dr. Vanessa Hanick (emergency physician, former active-duty Army, now National Guard) and 1SG Cy Clayton (Ranger Regiment veteran, currently a conventional Role 2 first sergeant) deliver a blunt assessment of a critical readiness gap: while whole blood is the agreed standard of care for damage control...

In this episode of the PFC Podcast, Dennis sits down with missionary surgeon Jason to cut through the noise on real-world wound care in austere and unconventional warfare environments. From the bridge two miles from the front to resource-scarce guerrilla settings, Jason shares hard-won lessons on getting tourniquets off, aggressive debridement, and keeping patients from dying of infection weeks la...

Recorded live at SOMA 26 Pierre Pasquier (France) and his German counterpart deliver a clear-eyed assessment of how European military medical systems are preparing for large-scale combat operations and major engagements, drawing heavily on lessons from Ukraine. They examine the scale of expected casualties, the return of mass-casualty and prolonged-care realities, the threat of multi-drug-resistan...

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Mitch (U.S. family practice/ER physician) and Augustine (frontline surgeon with five years of experience) to unpack what it actually takes to build and sustain mobile surgical capability in a high-threat Asian conflict zone. They share the hard-won realities of operating close enough to hear the fighting—often within a mile...

Recorded live at SOMA 26 Dr. Emily Johnston (Cascadia Mountain Institute) and SFC Ezequiel Mendoza (Arctic Dustoff, Fairbanks) deliver a hard-hitting, field-validated look at how standard tactical medical gear and medications actually perform—and fail—in true Arctic and extreme cold conditions. Drawing from cold-soak testing, simulated combat exercises, and real operational experience, they break...

In this essential episode of the Prolonged Field Care Podcast, Dennis sits down with pediatric intensivist Dr. Sara Bibbens to tackle one of the most challenging and anxiety-inducing scenarios in austere medicine: pediatric burns . From initial trauma assessment using MARCH/ABCDE to nuanced airway decisions in small children, burn resuscitation formulas, fluid management pitfalls, hypothermia prev...

In this presentation, we take a deep dive into the 300-year history of mobile surgery supporting land campaigns — from Dominique Larrey’s ambulance volantes through the Letterman system, Arnhem, the Falklands, Mali, and the current Russia-Ukraine war. Drawing on rare surgical memoirs, battle maps, and personal accounts, the discussion extracts the recurring problems that technology has never fully...

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex, CEO of Shannon Mechanics, a Ukrainian company that has produced more than 8,000 drag stretchers and over 330,000 immobilization splints for the front line since the full-scale invasion. Alex shares the raw story of how the company started with scrap materials and construction-store aluminum during the early chaos of 2...

In this episode of the Prolonged Field Care Podcast, Dennis sits down with J.R. Pickett — unpack the controversial and high-stakes topic of what used to be called excited delirium. They dig into the history of the syndrome (Bell’s mania, acute exhaustive mania, agitated delirium), why major organizations including ACEP, ACMT, and the National Association of Medical Examiners have rejected the term...

In this raw and eye-opening episode of the PFC Podcast, Dennis sits down with Jason, a general surgeon who completed nine combat deployments (seven in special operations) and has since operated in caves, dirt-floored schoolhouses, living rooms, and active conflict zones across multiple countries with nothing but a small team and minimal kit. Jason breaks down the hard truths of “guerrilla surgery”...