207-OTC Drugs for Austere Primary Care

In this episode of CoROM Conversations, Aebhric O'Kelly is joined by Dr Bill Vasios to discuss one of the most overlooked aspects of remote and austere medicine: the intelligent use of over-the-counter (OTC) medications in austere primary care.Rather than focusing on advanced equipment and prescription drugs, this discussion explores how a carefully selected collection of inexpensive, widely available medications can effectively manage many of the illnesses and injuries encountered in remote, expeditionary, humanitarian and disaster settings.The conversation emphasises clinical reasoning, careful assessment, conservative prescribing, and making the most of simple interventions before escalating treatment.Chapters00:00 – Introduction: Why OTC medicines matter in austere medicine02:22 – Traveller's diarrhoeaAssessmentOral rehydrationLoperamide: when to use it (and when not to)06:54 – Upper respiratory infectionsSymptom managementSalt-water garglesSaline spraysWhen antibiotics are unnecessary13:34 – Musculoskeletal injuriesPain packsDiclofenacPatient-guided pain managementRICE and the ice debate20:45 – Allergic rashes and contact dermatitisHydrocortisoneAntihistaminesOatmealRecognising anaphylaxis23:02 – Insect bites and stingsLocal treatmentCold therapyWhen to escalate care25:21 – DehydrationOral rehydrationIV versus oral fluidsHydration strategies in the field29:59 – Heat illnessCooling methodsField managementPreventing heat injury32:15 – Acid reflux in austere environmentsAntacidsGingerPractical management tips32:15 – Minor wound careIrrigationSoap versus antisepticsDakin's solutionAlcohol and iodinePractical wound cleaning36:45 – Building the ideal austere OTC medical kitEssential medicationsDressingsTapeWater purificationSplintsEpiPensMulti-use equipment41:20 – Final discussion, audience questions and wrap-upThe discussion concludes by assembling a practical remote medicine kit, including:Oral Rehydration Salts (ORS)ParacetamolIbuprofenLoperamideAntacidsOral antihistaminesHydrocortisone creamAntifungal creamTopical diclofenacZinc oxide tapeCohesive bandage (Coban/Vet Wrap)SalineSoapCling filmDressingsGauzeSunscreenWater purification equipmentSAM splintsEpiPenCompact medication organiser (FOLCA)Key Take-Home MessagesGood assessment should always precede medication.Oral hydration remains the cornerstone of treating dehydration.Many common conditions can be managed safely with inexpensive OTC medications.Every item carried should ideally have multiple uses.Patient education and involvement improve outcomes.Simple treatments, applied correctly, are often more effective than complicated ones.Featured SpeakersAebhric O'Kelly: Paramedic, educator and Rector of the College of Remote and Offshore Medicine.Dr Bill Vasios: Physician Associate, educator and specialist in austere and remote healthcare.Resources MentionedWorld Health Organization Oral Rehydration Solution (ORS)Wilderness Medical Society clinical practice guidelinesJoint Trauma System Clinical Practice Guidelines (JTS CPGs)Bristol Stool ChartOttawa Ankle RulesListen, Learn, DeployWhether you're preparing for an expedition, humanitarian mission, offshore deployment or remote clinic, this episode provides practical, evidence-informed advice on building a lightweight, effective medical kit capable of managing the conditions you are most likely to encounter.