Prolonged Field Care Podcast

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Mike Falk — pediatric ICU physician with multiple deployments to Iraq, Gaza, and Ukraine — for a raw, practical, deep dive into pediatric care when you’re the only asset and evacuation is denied.Most combat medics carry 99% adult gear. Kids still show up. Dr. Falk breaks down the absolute minimalist kit that actually works in austere and combat environments: canine tourniquets for toddlers, the single blue IO you really need, simplified airway choices, push-pull resuscitation with a syringe and stopcock, and a field-expedient needle cric setup.Then he walks through three real cases that expose the brutal decision-making required in prolonged field care:A 4-year-old pulled from rubble with a head injury who decompensates from rising ICPAn 8-year-old with a penetrating chest wound and tension pneumothorax at the thoracoabdominal junctionA 4-year-old with an infected blast wound fracture who develops septic shock days later in a denied environmentYou’ll learn weight-based dosing that actually works in the field, why kids decompensate differently, how to mix and run an epinephrine drip with limited supplies, the realities of black-tagging children in mass casualty events, and why these cases stay with providers long after the mission.Key Takeaways:The truly minimalist pediatric kit that won’t break your weight limitPractical field management of rising ICP when you have no CT or neurosurgeryPush-pull volume resuscitation and epinephrine drip mixing for pediatric shockWhy penetrating trauma at the 6th–7th rib level is often thoracoabdominalThe emotional and ethical weight of black-tagging kids — and why you must train itMalnutrition’s hidden impact on wound healing and sepsis in prolonged scenariosChapters00:00 - Welcome & Why Most Medics Are Unprepared for Pediatric Patients00:57 - The Bare Essential Pediatric Combat Medic Bag02:25 - Canine Tourniquet for Under-2s & Minimalist Hemorrhage Control02:25 - Vascular Access: Why the Blue IO is Usually All You Need03:22 - Simplified Airway: OPAs, NPAs & i-gel Sizes That Actually Matter03:22 - ET Tubes: Why Only 4.0, 5.0 & 6.0 Cuffed Are Necessary04:24 - Push-Pull Resuscitation Technique (Syringe + Stopcock)04:56 - Needle Cricothyrotomy Setup & Critical I:E Ratio Warning07:09 - Case 1 Begins: 4-Year-Old Blast Victim Pulled from Rubble08:47 - Initial Assessment, C-Spine Considerations in Kids & Access12:16 - GCS 11, Pain Control & Why Fluids Make Sense Early14:17 - Hours Later: Decompensation & Rising ICP18:17 - Positioning, Hypertonic Saline Dosing (5 mL/kg) & Decision to Intubate23:13 - Ketamine-Only Intubation, Permissive Hyperventilation & Realities27:51 - The Emotional Toll: Black Tagging Kids in MCI29:44 - Case 2: 8-Year-Old with Right Chest GSW & Tension Pneumothorax31:36 - Chest Seal + Needle Decompression (Anterior Approach Preference)34:23 - Blood Resuscitation (10 mL/kg) & Why Location Matters (Diaphragm Level)40:20 - Case 3: 4-Year-Old with Infected Blast Wound Fracture – Septic Shock42:51 - Broad-Spectrum Antibiotics & Source Control in Denied Environments45:26 - Push-Pull Boluses, Epinephrine Drip Mixing & Permissive Hypotension51:09 - Malnutrition’s Impact on Healing & Infection in Prolonged Care56:49 - Final Lessons: Training Black Tags, Calling for Help & Provider PTSD57:32 - Outro & Where to Find More PFC ContentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the PFC Podcast, Dennis sits down with David Plaster — former U.S. Army combat nurse, medic, and 68 Delta who has lived and worked in Ukraine since 2012, long before the full-scale invasion. David pulls back the curtain on one of the most remarkable stories in modern tactical medicine: how Ukraine built resilient, dispersed, underground manufacturing networks for hemostatic gauze and tourniquets when conventional supply chains collapsed or became targets.From the very first improvised IFACs in 2014 (duct-tape chest seals and all) to scaling production of Krovin Goss / Hemostat gauze at roughly $1 per meter and developing a functional “cat-style” tourniquet that Ukrainian and U.S. SOF tested and trusted, David shares the real mechanics of wartime medical logistics. He explains pre-planned basement factories, compartmentalized production across multiple hidden sites, the shift from volunteers to paid war widows and veterans’ families, rigorous quality control, and the constant fight against opportunists, “carpet baggers,” and adversarial intelligence collection.This is far more than a war story — it’s a masterclass in austere medical manufacturing, supply-chain resilience, and why training and knowledge will always outperform gear alone.Key Takeaways:Pre-war planning and deep personal networks (built years earlier) are the real force multipliers when supply chains get bombed or corrupted.Highly motivated local workforces — especially people with direct skin in the game (war widows, veterans’ families) — can deliver exceptional quality and output even in dispersed, low-tech underground conditions.Dramatic cost advantages ($1/m hemostatic gauze vs. $10+ imported) free up resources to buy more of everything else and keep production sustainable.Dispersed, multi-site manufacturing with compartmentalized components dramatically increases survivability and operational security.Functional analogs that are properly tested (double-blind SOF trials included) can serve as effective bridges when premium Western gear is unavailable or too expensive.The biggest failure point in tactical medicine is almost never the gear — it’s implementation and mastery of the basics by everyone, not just medics. Tourniquet application, conversion/repositioning, and preventive medicine thinking belong at the squad-leader level.Medics must operate as advisors and educators. Command emphasis on these skills across the force (not just in the aid bag) is what actually moves the needle on survival.Chapters:00:00 – Introduction & David Plaster’s Background (U.S. Army combat nurse in Ukraine since 2012)02:30 – Early Days: 2014 Improvisation, First IFACs, and the Complete Absence of Western TCCC06:00 – The Krovin Goss / Hemostat Gauze Story: Chemistry, Corruption, and the Pivot Underground11:30 – Going Underground: Pre-Planned Basements, Plan B/C/D, and Dispersed Manufacturing Strategy16:00 – Why the Tourniquet Project Started: Fake Chinese Gear, Expensive CATs, and Local Demand23:30 – The Manufacturing Model: Volunteers to Paid Staff, War-Affected Workers, and Quality Control27:00 – Security Realities: Protecting Sites from “Carpet Baggers,” Visitors, and Adversarial Interest30:00 – Bigger Lessons: Training Failures, ASM/Tourniquet Conversion Changes, and Why Knowledge > Gear36:00 – Preventive Medicine Mindset, Medics as Advisors, and Building Systems That Actually WorkFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠