This is the first in a series of posts introducing you – our team abroad – to our team here in the field. Eli Miller, a Paramedic who joined us from Alabama, just as GRM moved our Trauma Stabilization Points into the Old City of Mosul for the final push of the battle. A former Combat Medic in the US Army, Eli is has not only advanced training like ACLS, PALS, and WEMT, but has experience with All Hazards Disaster Response and Field Management of Chemical and Biocasualty.

While he’s not in the field, he runs Red Meat Steel in Alabama – check them out!

He recently talked about some lessons learned while on the frontline. Thank you Eli for being a part of our team!

40 Thoughts from being forward in flip flops.

1. Tactical Combat Casualty Care works and the guidelines at each update will give your patient the greatest chance of survival if you do your part.

2. A. C. T. Assess. Cease life threats. Treat everything else. (Direct Pressure LLC)

3. HABC – Hemorrhage Airway Breathing Circulation. You can have a great airway and respirations but if your patient is dumping that life liquid called blood at each breath its completely invalid.

4. A rapid trauma assessment is just that, rapid.

5. Don’t get trauma fixation. Compensation is only good for so long.

6. If you are going to change the outcome it will be done in 10 minutes or less.

7. Take ownership of your patient.

8. Delegate tasks. This makes you talk and talking keeps you calm and allows you to better focus on the life threats.

9. Triage saves lives. Good triage saves more.

10. The job of a line medic is to be a force multiplier plain and simple.

11. Do not take unnecessary risks, there are plenty that will be necessary.

12. Great BLS can prevent the need for good ALS.

13. Anything other than calm can be a killer in itself. If you need to chemically calm your patient then snow hard and snow fast.

14. If you think you are going to have to drop a tube you probably will. Have it prepped. Have your meds ready.

15. Forget the LMA, go I-Gel all the way.

16. Unlike the TSA, TXA ( Tranexamic acid ) actually works. Learn it.

17. Tiny holes on the outside often mean big holes on the inside.

18. Tourniquets go high and tight, it’s that simple. Put them on single bones. When they are tight, tighten them some more.

19. Positional hypotension is still hypotension. Proper positioning prevents poor perfusion.

20. There are a million reasons to carry gorilla tape and not a single one to not.

21. You can have great interventions but it doesn’t mean jack if you don’t have even better timing.

22. If you don’t believe your interventions can fail then you probably haven’t had them tested.

23. Reassess , reassess , and reassess some more.

24. Trauma naked is trauma naked even at 120 outside. Keep your patient warm.

25. Shitty care makes shocky patients real quick.

26. You never know as much as you think you do when you need it.

27. Stay humble, someone always knows more.

28. When you are the only one in the back of truck with a patient, no one knows more than you.

29. Sacrifice time, sacrifice sleep, sacrifice equipment but don’t sacrifice you.

30. Be selfish. If you don’t take care of you, you cannot take care of your patient.

31. Don’t get conflicted. When you hand off your patient they are no longer your patient or your responsibility . Relax, you will get another shortly.

32. You cannot save everyone and the way it normally goes it will be that truly innocent child that passes and the oxygen thief that lives.

33. If you see a canoe there is probably nothing you can do that will change the outcome.

34. Work the holes not the soul. Deep packing and direct pressure comes before deep prayer.

35. There is a reason it always be said as practicing medicine.

36. Mistakes are made once. Fuck ups are repeated.

37. “Anything that falls under something with triad in the name is going to make for a bad time.” – Doc Smiley

38. If knowledge is half the battle, luck is the other half.

39. When working an ice cream patient (GSW to the butt) and your packing wounds only to see scars exactly an inch above the entrance and exit where they where butt shot before, let all the other medics know. There is humor where there is no Good Humor.

40. There are fucking reporters and reporters that give a fuck. Not much in between the world over.

“You got to play for keeps cause aces tend to stick with dealers” Machine Gun Kelly

-Just a pig farmer