PFC Podcast 284: Pediatric Trauma in Denied Environments

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 ICP
• An 8-year-old with a penetrating chest wound and tension pneumothorax at the thoracoabdominal junction
• A 4-year-old with an infected blast wound fracture who develops septic shock days later in a denied environment

You’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 limit
• Practical field management of rising ICP when you have no CT or neurosurgery
• Push-pull volume resuscitation and epinephrine drip mixing for pediatric shock
• Why penetrating trauma at the 6th–7th rib level is often thoracoabdominal
• The emotional and ethical weight of black-tagging kids — and why you must train it
• Malnutrition’s hidden impact on wound healing and sepsis in prolonged scenarios

Chapters

00:00 - Welcome & Why Most Medics Are Unprepared for Pediatric Patients

00:57 - The Bare Essential Pediatric Combat Medic Bag

02:25 - Canine Tourniquet for Under-2s & Minimalist Hemorrhage Control

02:25 - Vascular Access: Why the Blue IO is Usually All You Need

03:22 - Simplified Airway: OPAs, NPAs & i-gel Sizes That Actually Matter

03:22 - ET Tubes: Why Only 4.0, 5.0 & 6.0 Cuffed Are Necessary

04:24 - Push-Pull Resuscitation Technique (Syringe + Stopcock)

04:56 - Needle Cricothyrotomy Setup & Critical I:E Ratio Warning

07:09 - Case 1 Begins: 4-Year-Old Blast Victim Pulled from Rubble

08:47 - Initial Assessment, C-Spine Considerations in Kids & Access

12:16 - GCS 11, Pain Control & Why Fluids Make Sense Early

14:17 - Hours Later: Decompensation & Rising ICP

18:17 - Positioning, Hypertonic Saline Dosing (5 mL/kg) & Decision to Intubate

23:13 - Ketamine-Only Intubation, Permissive Hyperventilation & Realities

27:51 - The Emotional Toll: Black Tagging Kids in MCI

29:44 - Case 2: 8-Year-Old with Right Chest GSW & Tension Pneumothorax

31:36 - 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 Shock

42:51 - Broad-Spectrum Antibiotics & Source Control in Denied Environments

45:26 - Push-Pull Boluses, Epinephrine Drip Mixing & Permissive Hypotension

51:09 - Malnutrition’s Impact on Healing & Infection in Prolonged Care

56:49 - Final Lessons: Training Black Tags, Calling for Help & Provider PTSD

57:32 - Outro & Where to Find More PFC Content

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