Special Operations Medical Association

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**Special Operations Medical Association**

This podcast covers medical care targeted to the Special Operations medical community with a focus on providing prolonged care in austere environments.

Latest Episodes:

43: 5 Years of Prolonged Field Care Dec 16, 2018

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42: Wound Care Basics and Beyond Nov 27, 2018

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41: The Death of the Golden Hour Aug 13, 2018

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Episode 40: Medic Team Dynamics with Dennis and Doug Jul 27, 2018

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39: ETCO2 Jul 05, 2018

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Doug and Dennis talk about the application and limitations of monitoring ETCO2 in prolonged field care situations.

38: Far Forward Surgical Support Apr 13, 2018

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37: PFC from the NGO Perspective With Alex Potter of GRM Mar 29, 2018

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36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion Mar 10, 2018

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The Tactical Hemostasis, Oxygenation and Resuscitation(THOR) Group including the 75th Ranger Regiment, NORNAVSOF and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. In 2015 the Ranger Medical Leadership along with founders of the ROLO program published the paper, "Tactical Damage Control Resuscitation" outlining in detail why they chose to bring back fresh whole blood at the point of injury. Since that time further studies have strongly suggested that the earlier fresh whole blood was transfused, the greater the benefit to the patient. Shackleford et al demonstrated that the greatest benefit to a patient receiving fresh whole blood occurred within 36 minutes of injury. After 36 minutes no decrease in 24-hour mortality was found.

Blood must be replaced as soon as possible. The Committee on Tactical Combat Casualty Care also recommends FWB as the first line intervention for patients in hemorrhagic shock with blood products in both second and third place. We cannot ignore whole blood any longer if we wish to deliver the best possible battlefield care possible. Excuses citing logistical difficulty, concerns of safety or lack of information are unfounded. There are multiple ways to ensure our casualties are receiving fresh whole blood. The first is through the Armed Forces Blood program delivering cold stored O-Low titer blood to a Role 2 facility where it is picked up and pushed forward from there. Refrigeration is necessary in order to keep it below 4°C. If going out on mission insulated containers such as the Golden Hour or Golden Minute containers can be used to keep the blood within temperature specs for 24, 72 hours or longer. If dismounted, a transfusion can occur at or near the point of injury with pre-typed, screened and titered ROLO/SOLO donors. Other non-Ranger Special Operations units have since followed suit and have tweaked the name to suit them, hence the new SOLO(Special Operations Low-O) acronym.

35: Burn Care Priorities With Dr. Cairns of UNC Chapel Hill Feb 23, 2018

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34: Telemedicine to Reduce Risk in Austere Environments Jan 12, 2018

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Telemedicine is a crucial capability that must be planned and practiced. The base of knowledge that a SOF medic's knowledge encompasses includes many areas of medicine but generally lacks

the depth and experience of specialists available to consult. This depth of knowledge is almost universally available when making a simple telephone call to any number of docs willing to take a call at all times of the day and night. Don't let pride or hubris prevent you from seeking advice from someone more experienced than you in taking care of critically injured, complex patients. Telemedical consult is one of the most important core capabilities in a prolonged field care situation.

BOTH the medic making the call as well as the Provider receiving the call must practice and rehearse a telemedical consult placed from a field environment. The medic will gain confidence and be able to relay vital information efficiently in a timely manner. The provider on the other end will have to anticipate problems that the medic may not have thought of and help create a prioritized treatment care plan from incomplete information.

Trust must be built prior to an actual call being made under stressful conditions; trust in the receiving physician and, more importantly, trust in the process. Medics may be apprehensive in calling a complete stranger if they haven't made a test call or even better, a face to face meeting. If you build the rapport before the crisis, this won't be an issue. You may even have the time to prep a draft email who you are and your equipment, training level and usually a region where you will be if you think it will be pertinent.

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