210-Lessons from Northern Sweden and Ukraine

This week, Aebhric O'Kelly speaks with Christoffer Mäkitalo, a Swedish ambulance and anaesthesia nurse whose career spans remote prehospital care, the Swedish Civil Defence and Resilience Agency, military medicine and repeated training deployments to Ukraine.For Christoffer, prolonged care is not an unusual operational scenario. After 20 years working in northern Sweden, long response and transport times are part of routine ambulance practice. A call may involve a 45–60-minute response, followed by several hours of transport to a hospital capable of providing the required definitive care. With limited ambulance and helicopter resources covering enormous distances, clinicians must continually balance clinical need, transport decisions and system availability.The conversation then moves to Ukraine, where Christoffer has worked alongside Tactical Medicine North to support the development of TCCC, Combat Lifesaver, Combat Medic/Corpsman, instructor, blood resuscitation and ultrasound training. His next deployment will include piloting a two-day prolonged field care programme aimed at the CLS level.A central theme is that the changing battlefield requires prolonged casualty care skills to move further forward. Casualties may remain with combat lifesavers and medics for extended periods, making seemingly basic nursing interventions, keeping patients clean, dry and warm, managing elimination, monitoring wounds and preventing complications, increasingly important. As Christoffer puts it, many combat lifesavers had no healthcare background before the war; skills clinicians consider obvious must therefore be deliberately taught.Chapters00:00 – Introduction: Christoffer MäkitaloTwenty years of prehospital medicine, military nursing and civil defence work in northern Sweden.01:41 – When Prolonged Care Is Just Normal CareWhy one-hour-plus evacuation timelines are an everyday reality for ambulance clinicians in northern Sweden.03:44 – Medical Training in UkraineChristoffer's repeated deployments and the evolution from basic TCCC towards instructor development, blood resuscitation and ultrasound.06:20 – Taking Prolonged Casualty Care to the CLSPiloting a two-day prolonged field care programme and why these skills need to move beyond highly trained medical personnel.09:16 – Nursing Skills on the Modern BattlefieldWound care, hygiene, keeping casualties dry and warm, elimination and other fundamental care when evacuation is delayed.11:34 – The Battlefield Has ChangedWhy assumptions based on rapid evacuation and air superiority no longer reflect the realities being reported from Ukraine.12:56 – Sweden's Civil Defence and Resilience AgencyHumanitarian operations, international deployments and supporting UN and EU missions around the world.17:12 – Working as a Swedish Combat NurseCombining civilian clinical practice with military medicine 19:49 – Remote Ambulance Medicine in Northern SwedenWorking with limited resources, long distances and the need to become an effective clinical problem-solver.23:28 – When HEMS Is Not AvailableDeciding when to request helicopter support and the operational challenges of weather, icing and enormous geographical coverage.26:23 – Cross-Border Rescue and EvacuationCooperation with Norwegian and Finnish services and the capabilities available across Scandinavia.27:28 – The Swedish Ambulance NurseEducation, scope of practice, anaesthesia training and differences between civilian and military clinical capabilities.30:36 – Treat, Release or Transport?Why does transporting every patient simply not work when one ambulance journey can take six to eight hours?33:26 – Fixed-Wing EvacuationMoving patients over long distances for specialist and critical care unavailable locally.35:14 – Advice for the New Austere ClinicianCuriosity, humility, lifelong learning and finding the area of medicine that genuinely matters to you.