Progressive Medical Direction

04/30/21 • 64 min

Drs. Will Smith, Steve Rush, and Ben Walrath join us for a great conversation about the role of the military EMS director. These three men have accumulated significant experience leading MEDEVAC/CASEVAC organizations, and their perspective is valuable for flight medics and Flight Surgeons alike.
During the episode, the conversation frequently emphasizes the importance of educational resources for flight docs, especially:

deployedmedicine.com
The Joint Trauma System's Pre-deployment Prioritized Read Lists by Clinical Role
COL Robert Mabry's seminal papers:
- Mabry, R. L., & De Lorenzo, R. A. (2011). Improving role I battlefield casualty care from point of injury to surgery. US Army Medical Department Journal, 87-92.
- Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.
Medical direction courses at SOMSA

Furthermore, Dr. Smith highlights the National Association of EMS Physicians Military and Federal Agency Chapter, a relatively new effort in which Dr. Walrath has a leadership role.
Thanks for listening, and be sure to share your thoughts with us via dustoffmedicpodcast.com, on Facebook, or @dustoff.medic.podcast!

deployedmedicine.com
The Joint Trauma System's Pre-deployment Prioritized Read Lists by Clinical Role
COL Robert Mabry's seminal papers:
- Mabry, R. L., & De Lorenzo, R. A. (2011). Improving role I battlefield casualty care from point of injury to surgery. US Army Medical Department Journal, 87-92.
- Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.
Medical direction courses at SOMSA

Previous Episode

Propofol & Sedation

Dr. Steven Bradley joins us to discuss the SMOG Propofol guideline, along with sedation and analgesia pearls.
Lieutenant Commander Bradley is a U.S. Navy anesthesiologist, and he is very active in mentoring aspiring physicians.
During the episode, Trevor mentions the Military Enroute Care Performance Improvement Report 2019 Events, as well as Tyler Christifulli's 2018 FOAMfrat article on post-intubation strategies. Trevor also discusses using the Richmond Agitation-Sedation Scale (RASS). You can find an easy-to-use version of the RASS on page 29 of the Joint Trauma System's Pain, Anxiety and Delirium Guideline (CPG ID: 29). It's definitely a good one to print out and keep handy.
If you want to use this episode as part of your Table VIII medical training, use the following tasks per TC 8-800:

081-831-0010, Measure a Patient’s Respirations
081-833-0034, Manage an Intravenous Infusion

Next Episode

IV/IO Protocol

In this episode, Trevor and Morgan talk to Dr. Whit Harvey, USN, about one of the foundational skills of out-of-hospital care: IV and IO access. Dr. Harvey has done important research on IO efficacy, and he shares some of his findings about the pressure required to keep IOs flowing, as well as techniques to generate that pressure (it's more than you think!).
Additionally, Trevor mentions some critical points about flow rates through IV tubing and lock devices. This can be a blind spot for a lot of us; the convenience of a lock is great, but those couple inches of tubing can significantly reduce flow rates, and that is not ideal if you're infusing blood. There is some pain associated with flushing an IO, and this article has some good information about just how much Lidocaine you should be using to reduce your patient's discomfort.