1st Aid Prolonged Field Care updates

ComCamGuy

Remote Paramedical pain in the ass
Just released- DoD Prolonged Field Care guidelines



The wait is over…

The Role 1 Prolonged Casualty Care Guidelines for the entire DoD are now available here and on the Joint Trauma System website!


Home for a ton of combat medicine guidelines and data

Downloadable med cheat sheets, references, and planning guides
 

ComCamGuy

Remote Paramedical pain in the ass
The two small pouches on the face have general boo boo stuff like band-aids, neosporine, itch wipes and such.

the trauma stuff in this ruck is primarily to reload the MARCH belt, which is the primary initial trauma treatment set. (See below)
 

kyrsyan

Has No Life - Lives on TB
I'm guessing you have the skills for all of that. Our kit is much smaller, in keeping with my skill level. Although I do have some items in it because we discovered that local paramedics did not have them when we needed them.
 

ComCamGuy

Remote Paramedical pain in the ass
I'm guessing you have the skills for all of that. Our kit is much smaller, in keeping with my skill level. Although I do have some items in it because we discovered that local paramedics did not have them when we needed them.

I am a Certified Remote Paramedic, so I have a good jump on things, plus anything else I can convince my Medical director to let me do. Still won't let me do Neuro Boreholes in the field. However, in theory you can use the EZ-IO for that (I read a paper about it once) :p
 

ComCamGuy

Remote Paramedical pain in the ass
Pharm Principles for SOF Medics

1. A bad memory is better than no memory; the patient doesn’t get anything until his vital signs prove he can handle it.
2. You are expected to make pain manageable; not take it away completely – this would be total anesthesia. You have to make this clear to your patient. Know the difference between sedation, analgesia, and anesthesia as well as which drugs will work to those outcomes.
3. If you are going to sedate a patient, acknowledge that you will lose mental status as a vital sign. If you find yourself about to give an aggressive dosage of medication, take a minute to think. Ask yourself how it will complicate your situation, and then decide.
4. “Cookbook” formulas are only starting points. Every patient is unique and requires a tailored approach. Although we recommend that you have “cheat-sheets” stored with your medications, recognize that these are to guide you while under stress, not as a “one-size-fits-all” approach to sedation and pain control.
5. Titrate to effect. Be patient. Wait for the medication to peak. If you don’t know the time peak effect for each of your medications, see number 9.
6. Your first experience pushing controlled medications should not be in a crisis. If you carry the medication, you have an obligation to 1) undergo training by a currently practicing anesthesia provider, and 2) to administer the medication under supervision during real cases. A Powerpoint class does not qualify you…
7. Performing procedural sedation on your own is a big deal. Don’t put unnecessary pressure on yourself; consult a specialist if possible. Assemble your equipment, devise your plan, and attempt to brief that plan to a higher medical authority. Performing sedation will likely be one of many “big deals” you are dealing with under stress. Consult – it’s the standard of care.
8. If you are going to sedate, you need to have MSMAID covered. Monitor, Suction, Machine, Airway, IV, Drugs. A professional will have access to some form of these items if they are going to sedate. A BVM can be your machine, a pulse ox can be your monitor, but you must have these items covered in some form before you sedate.
9. Know all your drugs inside and out. Be able to rattle off the class of drug, indications, therapeutic dosages, half-life, time for peak effect, contraindications, adverse effects, usual concentrations, pitfalls, and your personal strategy for dilution and titration to effect.
10. Take care of your medications – if they fall outside temperature range, they may lose efficacy. If they are stored in an extreme temperature, hot or cold, (such as during a gear shipment) seek to replace them ASAP.
11. Avoid IM administration if possible. It is often extremely variable especially in a trauma patient who is not circulating well.
12. A sedated or intubated patient has a “watcher” at all times. This person must be trained to read your monitors, listen to breath sounds, re-confirm tube placement, and look for “red-flags”.
 

ComCamGuy

Remote Paramedical pain in the ass
“SHIPWRECK'S” GO-BY 2nd Edition

Copyright 1996

written by



FRANK CARVALHO

LT MSC USN

PHYSICIAN ASSISTANT

[ FORMER-HMC (SW)
DDG-40 ]




FOR USE BY MEDICAL PERSONNEL IN EXAMINATION PROCEDURES DURING PATIENT EVALUATION.



WHILE NOT ALL INCLUSIVE, THIS GUIDE

PROVIDES PERTINENT ASSESSMENT

GUIDELINES.
 

Attachments

  • SHPWREK.GBY.pdf
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ComCamGuy

Remote Paramedical pain in the ass
Wilderness Medicine Field Protocols Example
 

Attachments

  • CWS-Wilderness-Medicine-Field-Protocols-Feb-2021.pdf
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EMICT

Veteran Member
Serious trauma requires surgery. There are things one can do to prolong the time between injury and surgery, but surgery is the end product… and as a paramedic, one should know that.

Treatment without surgical intervention is like pissing in the wind. It feels good but each and every time, you still get wet.

Edited to add: One still has to have a provider/surgical intervention on the backside of the rescue randy sh!t.
 
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ComCamGuy

Remote Paramedical pain in the ass
oh, I agree wholeheartedly. I understand my position is the Pizza delivery guy. I have to get the pizza (patient) to you still warm.

All of the above is to help take care of the things that don't need surgical intervention or to help sustain the pt for as long as possible until said surgeon can be acquired.

As a Remote Paramedic I can treat and manage a lot in the field, but I also know there is a lot of things that need higher skillsets, equipment, experience and training for.

Things like retrobulbar hemorrhage, I can buy time and maybe preserve eyesight with a lateral canthotomy, but they still need the base problem fixed.
Like the conversation I had with our Doc when the topic of Pericardiocentesis came up. Sure, I can relieve the pressure on the heart, temporarily, and buy more time to get them the surgeon they need.
 

ComCamGuy

Remote Paramedical pain in the ass
And a lot of the stuff we learn and study is more medical sick call. For that, I can have a lot of baseline sick call meds and skills to bring to bear. A lot of times it's ten medical pts for every trauma, and nine of those trauma pts are minor (ortho/sprain/strain/splinters/minor burns etc)
 

night driver

ESFP adrift in INTJ sea
Had to dig for that link, mine had expired (website went away).

This is only going to help if one spends several full DAYS reading and doing some explanatory research to UNDERSTAND what is being discussed.

BEST of course would be to have access to a full EMT-P course or a WEMT-P course (or highly preferably BOTH!!).

Still, don't let that stop ya. SPEND the 2 weeks of concentrated reading. Yes, it IS 600+ pages. Now it CAN be bought in hard copy, but it ain't cheep! *I* would go for the B&W because I won't be distracted by the full color --ahem-- REALITY of it.
OTHERS might go for the full color so they understand what they will encounter.
 
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ComCamGuy

Remote Paramedical pain in the ass
I have the 2nd and 3rd pdfs, as well as a ton of others too big to post in this thread

paramedic is good

wilderness paramedic can keep you alive while he evacuates you

Remote paramedic can keep you alive while he evacuates you or can treat you in place so you can continue in the remote location you are in
 

ComCamGuy

Remote Paramedical pain in the ass
Since we are boiling here in Texas, to keep cool thoughts, here is some artic info
 

Attachments

  • Arctic PCC and PFC Capabilities (reduced.pdf
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