Matthew Sovine joins the pod for a quick conversation about research he's conducting into sustainment training for active duty flight medics. Have a listen and make sure to fill out the survey in your work email.

In this episode, Trooper Mike Allen joins us to discuss the Arizona State Police's Aviation Unit. Trooper Allen is a flight paramedic who came to AZDPS from the fire service. Mike discusses the history of the program, the criteria for flight medic selection, the types of missions they respond to, the types of continuing education they run, and some pearls of wisdom for medics looking to use their skills in the civilian sector.

Canadian Army Master Corporal Justin Weiler joins Max and Trevor to talk about his new country's rotary-wing medical program. Canada is one of our closest allies, but they have taken a different approach to clearing the battlefield. Listen up for interesting differences in how they equip and crew their aircraft. You can learn more about CMERTs capabilities at aerospace medicine.ca, and you can reach the CMERT team at fwdaeops&trg@forces.gc.ca. Have a listen and let us know what you think!

Seain, Keegan, and Joe were the last three DUSTOFF medics in Afghanistan during the 2021 U.S. withdrawal. In this episode, they describe their experience during the attack at Hamid Karzai International Airport's Abbey Gate.

Seain, Keegan, and Joe were the last three DUSTOFF medics in Afghanistan during the 2021 U.S. withdrawal. In this episode, they describe their experiences in the days and weeks leading up to the attack at Hamid Karzai International Airport's Abbey Gate. ProPublica is a non-profit news site that published a comprehensive account of the Abbey Gate attack earlier this year; you can read it here. The U.S. Central Command conducted an investigation into the facts and circumstances surrounding the attack; that report is available on the U.S. Naval Institute's website.

Max sits down with US Air Force Lt. Col. Michael Policastro, MD for a capabilities briefing on the Air Force's Critical Care Air Transport Team program. CCATT is a team of highly skilled clinicians who provide enroute treatment to our sickest patients, and Dr. Policastro goes in depth into not only CCATTs medical skills, but also their selection process, training, and team dynamics. Have a listen, share the podcast with colleagues who might enjoy it, and let us know what you think!

COL (ret.) Jonathan Newmark, MD finishes up a fascinating conversation with Max on nerve agents. Dr. Newmark is a true expert in this subject and his depth of knowledge makes this episode a must-hear. Have a listen, and let us know what you think!

COL (ret.) Jonathan Newmark, MD sits down with Max for an in-depth discussion of nerve agents. Dr. Newmark dedicated much of his career to researching the treatment of chemical and biological casualties, giving him an extraordinary depth of knowledge on this topic. Dr. Newmark retired from the military in 2013, but continues to serve as a professor of neurology at the Uniformed Services University of the Health Sciences. This is a rare opportunity to hear from one of the nation’s leading authorities on the medical response to chemical and biological warfare, and despite his extensive, high-level knowledge, Dr. Newmark tailors his comments very effectively to the role of the paramedic in these events. Have a listen, and let us know what you think!

Max sits down with David Shablak to discuss how to conduct high-quality training at the unit level. David is the co-host of the SimGeeks Podcast, a paramedic, and an expert in healthcare simulation. This is a great conversation for Medical NCOs and platoon-sized unit leaders who build and conduct training at their level. During the conversation, David mentions a number of different resources for training, including the "This Old Man Manikin" series on his own YouTube channel, the Laerdal LLEAP software (we're not sponsored by them or anyone else), and the International Nursing Association for Clinical Simulation and Learning. David also discusses credentialing in the simulation profession and opportunities for more learning through the Society for Simulation in Healthcare. Have a listen, share this episode, and let us know what you think!

Sgt. 1st Class Christopher A. Celiz was awarded the Medal of Honor for heroic acts during an engagement with the enemy in Paktia Province, Afghanistan, on July 12, 2018. SFC Celiz saved the life of a wounded soldier from a partner force, and later used his body as a shield to cover the DUSTOFF aircraft that arrived to retrieve the wounded. SFC Celiz was mortally wounded during the engagement. In this episode, we finish our conversation with the lead flight medic and pilot in command of the aircraft present that day. SFC Celiz is an American hero, and his actions saved many lives. The DUSTOFF crew from had a unique perspective, and by hearing from them we can both gain first-hand insight into SFC Celiz's bravery, and honor his memory.

Sgt. 1st Class Christopher A. Celiz was awarded the Medal of Honor for heroic acts during an engagement with the enemy in Paktia Province, Afghanistan, on July 12, 2018. SFC Celiz saved the life of a wounded soldier from a partner force, and later used his body as a shield to cover the DUSTOFF aircraft that arrived to retrieve the wounded. SFC Celiz was mortally wounded during the engagement. In this episode, we talk with the lead flight medic and pilot in command of the aircraft present that day. SFC Celiz is an American hero, and his actions saved many lives. The DUSTOFF crew from had a unique perspective, and by hearing from them we can both gain first-hand insight into SFC Celiz's bravery, and honor his memory.

Dr. Haney Mallemat, a triple-boarded critical care physician and Editor-in-Chief at criticalcarenow.com, joins us to discuss all things vasopressor related. During the interview, Dr. Mallemat mentions the Arginine Vasopressin During the Early Resuscitation of Traumatic Shock (AVERTShock) trial. You can find a summary of that study here, and deployedmedicine.com has a good video discussing the trial as well. Dr. Mallemat also mentions a study describing a "central line-less" ICU while discussing the safety of vasopressin administration through peripheral IVs. You can find that study here: Cardenas-Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of hospital medicine, 10(9), 581–585. https://doi.org/10.1002/jhm.2394

There's a new Training Circular 8-800, Medical Education & Demonstration of Individual Competence (MEDIC), and it is a major change from the last version. This episode is a deep dive into the new TC with the primary enlisted authors, MSG Kaleb Twilligear and MSG Hunter Black. Listen up as they talk about returning the responsibility for a ready medical force to the NCO level. Much of the conversation involves focusing on basic skills, from TCCC at deployedmedicine.com, to the 8-Step Training Model, to Troop Leading Procedures, the 68W STP, and even the Warrior Tasks and Battle Drills in STP 21-1-SMCT. F2s are the most highly trained medics in the conventional force, and we have a responsibility both as medics and NCOs to be familiar with these documents and ensure that we are meeting the standards they set forth. The conversation also includes some strategies on how to work with your leadership on improving medical training at your unit, with a mention of a study linking a provider's familiarity with TCCC to the proficiency of the medics they supervise. There's also a discussion of a study from the Government Accountability Office detailing shortcomings in military medical training. Have a listen and let us know what you think!

Dr. Steven Schauer returns to the podcast with Trevor and Morgan to talk about pain management. Managing pain is a complex topic involving both different types of pain and different medications. During the conversation, Dr. Schauer mentions JTS CPG 61, Analgesia and Sedation Management During Prolonged Field Care. You can find this on the link at our website, or by searching "JTS CPG." Military members, use your free UpToDate access to read their article entitled "Pain Control in the Critically Ill Adult Patient." If you don't have UpToDate access yet, read the article at nextgencombatmedic.com on how to get an AVL account. It's worth your time. Finally, Dr. Schauer mentions an article he co-authored last year: Bebarta, G. E., Bebarta, V. S., Fisher, A. D., April, M. D., Atkinson, A. J., McGhee, L. L., & Schauer, S. G. (2021). An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital. Military medicine. Have a listen, and let us know what you think!

Dr. Sean Stuart finishes up a discussion on chest tubes with Claire and Morgan. This episode discusses some of the finer points of the procedure. Dr. Stuart also describes how to make an inexpensive task trainer so you can practice thoracotomies at your unit. Finally, he describes an improvised Heimlich valve that you can make with an exam glove if you're in a pinch and don't have a chest drain system immediately available. Photos on our website! Have a listen and please let us know what you think!

Dr. Sean Stuart joins Claire and Morgan for the first in a two-part series about chest tubes. Dr. Stuart is a Navy emergency medicine physician and is the Research Director of the Combat Trauma Research Group. This first episode covers a lot of ground, from a detailed discussion of the procedure itself to a thorough exploration of a recent paper contrasting the efficacy of traditional chest tubes against pigtail catheters. Dr. Stuart calls out a couple important pearls, notably that oxygenation status is a very late finding for tension hemo/pneumothorax, and separately, that breath sounds are unreliable in determining whether a patient has this type of injury. A recent paper gets some attention in this episode, and really illustrates why it's important to dig deeper than the abstract and conclusion: Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813. You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com. Have a listen and let us know what you think!

We all learned it. We've all done it. And we (mostly) all know that it's wrong. Dr. Seth Collings Hawkins joins Trevor and Claire to discuss spinal immobilization. Rigid immobilization of trauma patients is entrenched dogma, but we've probably all heard that this procedure is not just without benefit, but is in fact harmful to our patients. Dr. Collings Hawkins is a leader in the wilderness EMS community, and he breaks down the reality of spinal immobilization and how we can all do better. Listen up as he talks about the history of this intervention, discusses appropriate uses for the rigid backboard and c-collar, and then shows how we can do better. This is important information for everyone to hear, from new medics to experienced flight surgeons. Have a listen and let us know what you think!

Captain Madison Anderson, RN, joins Claire and Morgan to discuss the pre-hospital care of sexual assault victims (SMOG SPECIAL POP V). It's a difficult topic, but it is critical for flight medics to understand the specialized care this patient population requires. CPT Anderson is a Sexual Assault Medical Forensic Examiner (SAMFE), and she makes important points about balancing patient care protocols with the need to minimize disturbing the victim. She also speaks extensively about the continuum of care for sexual assault victims, and gives important context to where pre-hospital care fits into a victim's path to healing. CPT Anderson frequently refers to MEDCOM Regulation 40-36, Medical Facility Management of Sexual Assault, which is available with a CAC at the Army's Office of the Surgeon General MEDCOM Publications Portal. Take the time to listen to this important conversation, and let us know what you think!

Lt. Col. Joe Maddry joins Max and Morgan to talk about SMOG Medical XIX, Toxic Ingestions. Toxicology is extraordinarily complex, and this discussion ranges beyond ingestions. Dr. Maddry is an emergency medicine physician and has completed a toxicology fellowship. Listen up as he breaks down initial treatment for a range of emergencies from reptile bites to rocket fuel inhalation to intentional overdose. Dr. Maddry is the Deputy Commander of the Walter Reed Army Institute of Research and is extensively published on a variety of topics, with much of his research devoted to pre-hospital and enroute care. If you don't have an account through the AMEDD Virtual Library yet, check out this article from nextgenerationcombatmedic.com on how to get access to the medical journals where Dr. Maddry and others publish their important research. And while there is not a poison control center exclusively for the military, all of the domestic poison control centers communicate with each other and can get you help with treating poisoned patients. Keep 1-800-222-1222 in your phone! And whether you're at home or deployed, you're not alone when you're trying to treat a complex toxic emergency. If you need a consult, call the DOD Advanced Virtual Support for Operational Forces program, or ADVISOR: 1-833-ADVSRLN (1-833-238-7756 or DSN 312-429-9089).

New Zealand Army Nursing Officer Captain Buffy Little joins Max and Trevor to talk about her service's rotary-wing MEDEVAC program. New Zealand is one of our closest allies, but their Army's small size and remote geography mean their operations are dramatically different from ours. Listen up for interesting differences in how they equip and crew their aircraft, as well as major differences in their pre-hospital training and certification levels. Captain Little is an inspiration. She's deployed with the New Zealand Army, beat cancer twice, and was one of the first rescuers on scene of the 2019 White Island volcano eruption. Now she's training to compete in the Invictus Games, and is a founding member of Kaitiaki Ora—Tactical Medicine New Zealand. Have a listen and let us know what you think!