This week, Dr John Quinn joins Aebhric O’Kelly to discuss the emerging field of Damage Control Procedures (DCP) for austere, prolonged, and contested environments.Dr Quinn explores the growing operational gap between Tactical Combat Casualty Care (TCCC) and definitive surgical care, particularly in Ukraine and other high-threat environments where evacuation delays can extend for days. The discussion covers the development of DCP curricula, governance challenges, telemedicine oversight, surgical skills for non-surgeons, and the operational realities driving innovation in prolonged casualty care.The episode also examines lessons learned from Ukraine, the future of austere procedural medicine, and how modern conflict is reshaping medical doctrine across NATO and partner nations. Chapters00:05 – Introduction to Dr John Quinn and current operational work00:39 – Volunteering in Ukraine and advancing damage control resuscitation01:20 – What are Damage Control Procedures (DCP)?02:01 – The gap between TCCC and definitive surgery03:25 – Why delayed evacuation changes medical doctrine04:29 – Surgical skills for paramedics, nurses, and combat medics05:20 – Governance and legal challenges surrounding DCP06:26 – How surgeons may react to DCP concepts07:16 – Telemedicine oversight and surgeon mentorship in austere care09:11 – Surgical expertise shaping the DCP curriculum10:08 – Overview of the DCP programme structure11:16 – Tier 1 skills: surgical airways, thoracostomy, tourniquet conversion, traumatic amputations12:43 – Tier 2 skills: laparotomy, external fixation, fasciotomy, advanced burns14:29 – Tier 3 concepts: burr holes and REBOA15:47 – Future concepts: haemofiltration and advanced austere ICU care18:22 – Why DCP sounds controversial — and why it may still be necessary19:16 – Telemedicine vs autonomous procedural decision-making22:05 – Clinical governance and parallels with paramedic evolution23:38 – Why basic life support remains foundational25:35 – Historical parallels with early paramedic medicine26:36 – Expansion of chest tube and intraosseous use in Ukraine30:11 – What happens next for the DCP pathway?31:24 – The importance of listening to Ukrainian clinicians32:21 – DCP beyond special operations medicine33:32 – Introduction to the Disaster Health Institute (DHI)35:37 – Bridging strategic and operational medicine36:17 – SOF Combat Medical Conference (CMC) discussion38:19 – Upcoming RCSEd webinar on DCP39:30 – Lessons learned from Ukrainian workshops and role-zero care41:40 – Drone warfare, attacks on medical personnel, and evacuation challenges43:18 – Why Ukrainian medics are requesting Tier 1 and Tier 2 DCP capability45:18 – Upcoming DCP workshop at Medicine in the Mediterranean46:31 – Advice for clinicians entering austere medicine50:27 – AI, education, digital twins, and the future of medical contentGuest bioDr John Quinn is an operational clinician, researcher, and educator working across prehospital care, austere medicine, disaster health, and military medicine. Originally trained as a paramedic, he later completed both medical and doctoral training and now works clinically within the United Kingdom while supporting medical projects and training initiatives in Ukraine.Dr. Quinn is involved in the development of Damage Control Procedures curricula and collaborates with international subject matter experts, surgeons, and operational clinicians to improve prolonged casualty care capability in contested environments.Disaster Health Institute is a collaborative network focused on disaster health, operational medicine, epidemiology, humanitarian response, and strategic healthcare preparedness. The organisation works with subject matter experts across Europe, North America, Central Asia, Africa, and South America to develop evidence-informed approaches to modern operational health challenges.

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