Takeaways
Courage in the absence of fear is stupidity.
Training should focus on knowledge, not just equipment.
The ocean's unpredictability complicates operations.
Effective communication is crucial in maritime environments.
Over-planning can lead to operational failures.
Training is essential for operational success.
Integrating with host nation partners enhances effectiveness.
Technology should be a last resort solution.
Operational flexibility is key in dynamic environments.
A joint effort is necessary for tackling complex challenges.

Chapters
00:00 Introduction and Context of the Mission
02:53 Challenges in Maritime Operations
05:38 Operational Planning and Flexibility
08:30 Communication Strategies in Maritime Environments
11:15 Training and Integration with Host Nation Partners
14:12 Operational Autonomy and Cross-Training
16:50 Emphasizing Training Over Technology
19:25 Conclusion and Call to Action

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Justin brings both battlefield experience and clinical expertise, while Dennis shares unfiltered war stories and hard-earned lessons. They draw on Homer’s Odyssey, Achilles in Vietnam, modern family systems theory, emotion-focused therapy (EFT), anthropology of tribal hunters returning to the village, and brutally honest spouse perspectives (shoutout to Angela Ball for the coffee-table truth bombs).

This isn’t another “do these 5 things and you’ll be fine” checklist. It’s a real talk about why coming home is hard — for the service member, the spouse, the kids, and the whole damn family system — and how to navigate it with eyes wide open.

Key Takeaways

• The transition home starts before you leave the sandbox — unrealistic expectations (“If I can just make it home…”) set most people up for failure.
• Anger is often the only “socially acceptable” emotion for warriors; underneath it usually lies fear, sadness, shame, or grief over missed time/missed life.
• Military and home are competing tribes with conflicting values, boundaries, and shame triggers — yelling works at work, but it nukes the dinner table.
• Spouses aren’t “just holding it down” — they’ve built an entire functioning system. Coming home = deliberate, careful re-entry, not storming the castle.
• Chronic leaving-and-returning (TDYs, schools, exercises) is as damaging as combat deployments — families don’t care if it’s “just training”; absence is absence.
• Healthy reintegration means we not me — appreciation, lowered expectations, co-regulation in traffic rage moments, and honest communication about what’s really happening emotionally.
• There is no smooth road. The healthiest couples/families acknowledge it’s bumpy, forgive missteps quickly, and keep talking.

Whether you’re an OGA guy with 15 TDYs, an infantryman coming off your first rotation, a spouse reading this description in tears, or a leader wondering why your guys are angry all the time — this episode is for you.

Chapters

• 00:26 – Justin returns; setting the stage for “coming home”
• 03:16 – Evolution of post-deployment screening — what’s better now vs. then
• 09:59 – Acute vs. chronic homecoming — one big event vs. a lifestyle of constant comings & goings
• 13:18 – The spouse perspective (Angela drops truth bombs over coffee)
• 19:46 – Don’t discount non-combat deployments or training risks — it’s all cumulative family stress
• 22:38 – Emotion-Focused Therapy (EFT) basics — emotions are older than words
• 27:05 – Anthropology: hunters leaving the tribe, returning changed, and the danger of re-meeting
• 36:55 – Shame culture in the military vs. home — competing tribal expectations create anger & failure loops
• 42:25 – Anger as secondary emotion — fear, sadness, shame underneath
• 45:03 – Mismatched expectations on both sides (warrior welcome vs. “don’t touch my schedule”)
• 50:31 – Operator syndrome vs. spouse high-stress reality — high stress is high stress
• 54:29 – Ego check: coming home with an inflated “war hero” self vs. careful re-entry
• 59:23 – The minivan road-rage story — tribal rules don’t switch off overnight
• 01:05:35 – Building a culture of appreciation (Gottman style) without knife-handing it
• 01:09:43 – Listening without fixing — emotional acknowledgment first

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Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly.

You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery…

Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly.
REBOA

In this episode we explore the usefulness and limitations of this strategy in deployed settings and discuss the use of REBOA by non-physician providers in austere situations. He has written several articles on use of the REBOA and it is now one of the most promising and controversial adjuncts available for hemorrhage control of bleeding inside the box of the thorax, abdomen and pelvis. In order to do this o e would likely have to be within an hour of a facility that can repair the retired vessel as the lactic acid and other toxins would quickly build up causing a massive repercussion injury. To this end he discusses his strategy for partial REBOA during resuscitation that would leave the balloon partially inflated allowing a clot to strengthen and circulation distal to the balloon.

For more content, visit www.prolongedfieldcare.org

For more content, visit www.prolongedfieldcare.org

Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com

For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective

Despite firm CoTCCC and ICRC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, ‘they’ll take care of it at the next echelon.’ A great medic should not only treat their patient but set them up for success at the next echelon, as sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later.

But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you given those antibiotics? How is your airway and respiratory care? Did you replace any dirty IV or IO sites you placed in the field? Are you doing all your procedures an as aseptic manner as much as possible? When will you debride? Are you doing everything you can to prevent pressure ulcers?

When will you call for a telemedical consult? When your patient develops a fever? Blood pressure falling? Altered mental status?

Do you know how to dilute your 1:1000 epinephrine to use as a push dose pressor? (It’s in the Tactical Medical Emergency Protocols) Is an Epi drip approriate, why or why not? How much fluid will you give to help prop up that BP? All questions that the medic prepared for PFC should be looking to answer.

For more content, visit www.prolongedfieldcare.org

A couple things mentioned in the podcast are worth reiterating here:

After insertion you may get a large amount of urine in the tube and bag.

Empty the tube into the bag and empty the bag into a graduated cylinder or a Nalgene you have previously marked down to the mL. What?! It’s sterile right?

This does not count toward hourly output!

Record the amount as your inital out and then flush it.

This is when the hour and your recording begin.

Set your watch or egg timer you included in your PFC kit for 60 minutes.

When the alarm goes off, empty the tube into the bag and the bag into the cylinder.

Record this number down to the cc, as your UOP on your documentation chart for trending.

You should be trending 0.5cc/kilo/hour or about 30-50cc per hour

Foe more content go to www.prolongedfieldcare.org

Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com

For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective