What Would MacGuyver Do? Medical Excellence in Austere Settings

What Would MacGuyver Do?

June 1, 2022



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Kate Joyce, MD, MPH

Henry Ford Hospital EM/IM, PGY4
Twitter: @sceneisnotsafe
Instagram: @sceneisnotsafe  
EMRA*Cast Episodes


Lt Col Regan Lyon, MD, FACEP

Board of Directors, Special Operations Medical Association (2018-2022)
Assistant Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences 

Your patient has an arterial bleed and a tenuous airway. You've got 1 unit of blood, no vent, and no hospital within hours. Welcome to the world of austere medicine. Host Kate Joyce, MD, MPH (@sceneisnotsafe) and USAF Lt Col Regan Lyon, MD, FACEP, discuss the challenges of treating patients in the most extreme scenarios. 

Overview:  "Austere" medical environments are very resource-limited environments that may be related to man-made or natural disasters, wilderness, military deployments, or a practice setting that is remote from higher levels of care. On this episode, host Kate Joyce (@sceneisnotsafe) chats with Lt Col Regan Lyon, MD, FACEP, of the USAF Special Operations Surgical Team about working in austere environments in the military context.

Take-Home Points

  • Get comfortable with being uncomfortable. It's a fundamental requirement for working in austere environments.
  • If you can't go without electricity, Wi-Fi, or bathing for several weeks, austere environments may not be for you.
  • Emergency physicians are needed to work in austere environments not only in the military, but also in other parts of government, the private sector, and nonprofits (like Doctors Without Borders and the International Red Cross/Red Crescent).
  • Wilderness medicine training is strongly recommended.
  • If you need special ops training that goes beyond medicine (like tactical skills), this is almost always taught on the job.
  • Pay attention to ALL duties in the ED, since they may be yours in the field! Learn to hang blood, mix medications, troubleshoot ventilators, etc.

General Austere Medicine Resources


U.S. Government & Private Sector

  • National Disaster Medical System, which includes Disaster Medical Assistance Teams (DMAT) and Surgical/Critical Care Teams 
  • There are a number of consulting groups (Valkyries Austere Medical Solutions, Austere Medical Physicians) that offer private-sector opportunities for EM physicians. Most require completion of residency as well as board certification. 

Non-Governmental Organizations

Wilderness Medicine

Peer-Reviewed Literature

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