Despite our best efforts, endless training, and reading, some of our  patients will die.  This has been a taboo subject that is difficult to  broach in the best of times.  We aim to start a conversation here with  the hope that  it continues with your Medical Director, PA, Surgeon and fellow Medics  before you are ever faced with this difficult situation out on your own.   Often prolonged field care involves treating the most critically sick  or injured patients longer than you expect to.  Inevitably some of these  “sickest-of-the-sick” will not make it to see definitive care and you  will be left to ease the suffering during end of life care alone.  While  you may have to deliver end of life care by yourself, you may not have  to make all the decisions alone.  In this episode Dennis and Doc Powell discuss how to treat expectant  patients.  This could be as part of a multi-patient MASCAL or a happen  to a single patient who is critically ill or injured.  If it happens  during a MASCAL, once you are done treating your urgent patients, what  do you do when you go back to your expectant patients?  It’s common to  skip over discussing and training on losing patients…  Taboo even.  The  fact is that it will eventually happen to some of us; No matter how good  of a medic we are, patients will die.  Doc Powell has spent innumerable  hours in Intensive Care Units with the best and brightest medical teams  a patient could hope for.  Even in this setting the top notch care,  medicines and interventions are not enough and patients code and die.   This is part of medicine whether we talk about it openly or not and  while many of these situations will be complicated and stressful we hope  to give you a few tools to help manage the situation in a more  professional manner.  How do you decide if your critically ill patients are expectant, when  alone in a tactical or resource strained environment?  After that decision is made, what can we still do?   How is telemedicine different for curative vs. palliative cases, if at  all?   For more content, visit www.prolongedfieldcare.org

Being able to calm and sedate patient in operational or prolonged field  care situations may be a valuable skill.  Here are our thoughts on  sedating your patients when patient comfort and safety are an issue?   For more content, visit www.prolongedfieldcare.org