CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.

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.

This week, Aebhric O'Kelly is joined by William Krupa, who recently graduated from the MSc Austere Critical Care programme. They discuss wilderness medicine, tactical medicine education, prolonged field care, and his experience completing the MSc in Austere Critical Care at the College of Remote and Offshore Medicine Foundation.William shares his journey from infantry soldier to paramedic educator, discusses teaching Wilderness First Responder (WFR) programmes, reflects on attending the Medicine in the Mediterranean Conference in Malta, and provides an overview of his MSc thesis on austere mechanical ventilation using portable oxygen concentrators and closed-circuit systems.This episode explores how austere medicine education can reinvigorate clinicians, improve critical thinking, and bridge the gap between theory and operational practice. Chapters00:00 – Introduction to the episode and guest welcome00:41 – William’s current work in paramedicine, wilderness medicine, and tactical medicine education01:20 – Military background and transition into medicine02:30 – Repeating EMT training after military service03:53 – Why repeated teaching improves clinicians and educators05:07 – The value of teaching Wilderness First Responder (WFR) courses07:22 – Deep dives into improvised medicine during longer wilderness courses07:55 – The history of CoROM and how WFR led to degree programmes09:33 – William’s first trip to Malta for APUS and ICARE10:20 – Scenario-based learning and hands-on education at CoROM11:34 – The realism of the ICARE moulage and burn simulations14:05 – Medicine in the Mediterranean Conference experience14:51 – Ukraine battlefield medicine workshop and WPC certification15:40 – Graduation and earning the MSc in Austere Critical Care16:14 – Publishing research and future doctoral plans17:18 – Why William chose the MSc in Austere Critical Care19:23 – What makes CoROM different from other critical care programmes22:16 – Mentorship from MD-PhD faculty and practical education26:08 – William’s MSc thesis on austere mechanical ventilation27:39 – Using oxygen concentrators and closed-circuit systems in austere care29:28 – Research discussion: dual oxygen concentrators and FiO₂ optimisation31:15 – Challenges during the MSc programme33:32 – How the MSc changed William’s clinical practice34:44 – Suggestions for future development of the MSc programme36:47 – Teaching WFR in Utah with Black Swan and Human Path39:01 – Achieving Fellowship of the Academy of Wilderness Medicine (FAWM)41:08 – Why wilderness fellowships carry professional value43:46 – Advice for new medics entering austere medicine45:11 – Closing remarks and congratulations Key Topics • Wilderness medicine education • WMS FAWM • Tactical medicine and TC3 instruction • Prolonged Field Care (PFC) • Austere Critical Care education • Scenario-based simulation training • Improvised medicine • Mechanical ventilation in austere environments • Oxygen conservation strategies • Wilderness medicine fellowships • Medical education mentorship • International austere medicine collaboration Key Takeaways• Scenario-based education improves retention and operational performance. • Wilderness medicine often reignites clinicians’ passion for medicine. • Austere medicine requires adaptability rather than dependence on resources. • International collaboration broadens clinical understanding and perspective. • Practical mentorship from operational clinicians is critical in advanced education. • Mechanical ventilation in austere environments may be feasible with low-resource systems. • Long-form wilderness courses allow deeper exploration of improvised medicine concepts. • Continuous learning is essential for clinicians operating in remote and austere environments.

This week, Aebhric is again joined by Zach Andrews, who leads the latest episode of CoROM Conversations, which explores the recognition and management of severe malaria in resource-limited and austere environments. Drawing on field-relevant clinical reasoning, the discussion focuses on the progression from uncomplicated to life-threatening disease, with emphasis on Plasmodium falciparum as the primary driver of severe pathology.The conversation highlights the diagnostic challenges faced by remote medics, where laboratory confirmation may be delayed or unavailable, and underscores the importance of clinical pattern recognition, early intervention, and ongoing reassessment. Particular attention is given to complications such as cerebral malaria, severe anaemia, metabolic acidosis, and hypoglycaemia—all of which significantly increase mortality if not rapidly addressed.From a prolonged field care perspective, the episode integrates pragmatic strategies for stabilisation, monitoring, and evacuation decision-making. It reinforces the need for structured patient assessment using frameworks such as CABCDEFGH, along with trending vital signs over time. The discussion ultimately bridges tropical medicine with austere critical care, offering actionable insights for medics operating far from definitive care.Key Learning PointsSevere malaria is a time-critical diagnosis, most commonly associated with Plasmodium falciparum, requiring immediate treatment even before confirmatory testing.Red flag features include altered mental status, respiratory distress, severe anaemia, hypoglycaemia, and shock.Hypoglycaemia is both a complication of malaria and a side effect of treatment (e.g., quinine), necessitating frequent glucose monitoring.In austere environments, clinical diagnosis often precedes laboratory confirmation, requiring high suspicion in febrile patients with travel or endemic exposure.Fluid management must be cautious, balancing the risks of hypovolaemia and pulmonary oedema.Prolonged care requires integration of nursing principles (HITMAN, SHEEP VOMIT) to prevent secondary deterioration.Early administration of parenteral antimalarials (e.g., artesunate where available) is critical to survival.Evacuation planning should be initiated early, but delays must not postpone life-saving interventions.Timestamps00:00 – IntroductionOverview of the case and relevance to austere medicine02:30 – Pathophysiology of Severe MalariaMechanisms of microvascular obstruction and organ dysfunction06:00 – Clinical PresentationRecognising early vs severe disease in the field10:30 – Assessment FrameworksApplying structured approaches (CABCDEFGH, CPRO, BEAST)15:00 – Management PrioritiesAntimalarials, glucose, fluids, and airway considerations20:30 – Complications and MonitoringCerebral malaria, acidosis, anaemia, and respiratory failure25:00 – Prolonged Field Care ConsiderationsNursing care, documentation, and trending30:00 – Evacuation and Decision-MakingWhen and how to move the patient33:00 – Key Takeaways and Closing ThoughtsClinical Pearls / Take-Home MessagesTreat first, confirm later: In suspected severe malaria, delays in treatment increase mortality.Check glucose early and often: Hypoglycaemia can be rapidly fatal and easily missed.Think beyond fever: Altered mental status or respiratory changes may be the first sign of severe disease.Your greatest tool is reassessment: Trends in vital signs are more valuable than single data points.Good nursing care saves lives: Positioning, hydration, hygiene, and monitoring are critical in prolonged care environments.Suggested ReferencesWorld Health Organization. Guidelines for the Treatment of Malaria (latest edition).Joint Trauma System Clinical Practice Guidelines: Prolonged Casualty Care.World Health Organization. Severe Malaria (Tropical Medicine reference standards).White NJ et al. Malaria. The Lancet.

This week, Aebhric O’Kelly is again joined by Zach Andrews, a MSc Austere Critical Care graduate and expert in jungle medicine, who shares his extensive experience in remote critical care, setting up ICUs in challenging environments, and improving medical education. Discover practical tips for medical professionals working in remote areas and learn about innovative approaches to medical training and patient care.Chapters00:00 Introduction and Guest Introduction00:26 Zach Andrews' Background and Current Projects01:06 Role in Student Success Department02:34 Student Program Feedback and Challenges05:50 Faculty and Program Cost-Effectiveness11:27 Setting Up ICUs in Remote and Austere Areas20:42 Importance of Hands-On Assessment in Remote Settings23:00 The Jack of All Trades in Jungle ICU Setup25:18 Lessons from Masters of Austere Care27:33 SOMA Scholarship and Zach's Presentation29:34 Advice for New Medics in Austere Medicine30:52 Closing Remarks and Final Thoughts

This week, Aebhric talks with Alfredo Leal, who shares his extensive experience in emergency medical services, including his work with the WHO, offshore rescue missions, and medical training courses like AMLS and PHTLS. Discover valuable insights on pre-hospital care, medical assessment, and the future of emergency medicine training.Chapters00:00 Introduction to Alfredo Leal's Journey01:48 Experiences with the World Health Organisation04:10 Deployment in Ukraine and Its Challenges04:59 Advanced Medical Life Support Course Insights07:43 The Importance of Medical Training12:01 Differential Diagnosis in Pre-Hospital Care16:11 Dynamic Patient Assessment Techniques19:26 Teaching and Training in Emergency Medical Services23:52 Future of Emergency Medical Training27:48 Advice for New Medics in Austere Environments

This week, Aebhric O’Kelly is joined by Dr Michael Klopper, who recently earned his doctorate from CoROM and shares his journey from South Africa to becoming a doctoral candidate in AI, his extensive experience in remote medicine and mountain rescue, and his views on the future of AI in medical research and education. Discover insights on mountain medicine training, AI's role in healthcare, and practical advice for medical professionals in challenging environments.Chapters00:00 Introduction and Dr Klopper's background01:42 Early connection with the College and initial projects04:06 Setting up clinical placements and courses in South Africa05:44 East London clinical work and EMS programs07:28 Dr Klopper's Wilderness Medicine Fellow (FAWM) and future plans11:48 Dr Klopper's PhD thesis on AI in medicine18:19 The importance of search mechanisms and AI in research21:57 Risks and best practices for AI in academic research24:57 Advice for new medical professionals and outdoor enthusiasts28:48 Preparing for deployment in challenging environments29:30 The role of aviation safety and small details in rescue missions32:16 Closing remarks and future plans for Dr Klopper

This week, Aebhric O'Kelly is joined by Dr Aris Exadaktylos and Dr Susie DiMartini to discuss the critical need for specialised maritime medicine training. They explore the creation of the International Maritime Ships Doctors course, the unique challenges of offshore medical care, and the future of remote healthcare technology. They are the founding faculty for the new Faculty of Offshore and Maritime Medicine from CoROM. Chapters00:00 Introduction to Maritime Medicine Faculty02:14 Personal Journeys in Maritime Medicine05:02 The Need for Maritime Medical Training10:11 The Role and Responsibilities of Ship Doctors16:51 Innovations in Maritime Medical Care25:49 The International Maritime Ship Doctors Course29:03 Future of Maritime Medicine Education

This week, Aebhric O’Kelly is joined by Rhod Jordan and Bill Vasios as they discuss how to create an ICU in the jungle. They discuss setting up and managing a remote ICU in jungle environments, focusing on site selection, equipment, logistics, and medical considerations for field medics and responders.Chapters00:00 Introduction and Content Overview00:41 Premise and Scenario Setup for Jungle ICU01:33 Site Selection Criteria in Jungle Environments02:19 Environmental Challenges: Rain, Creepy Crawlies, and Hypothermia03:08 Privacy, Lighting, and Visibility in Remote Settings03:53 Creating a Functional Jungle Clinic Layout04:34 Lighting and Visibility Strategies at Night05:31 Accessibility and Zone Planning in Field Clinics06:09 Assessing Capacity: Multiple Patients and Beds07:01 Monitoring Equipment: Minimum and Advanced Options08:04 Power, Water, and Communication Logistics08:42 Prolonged Casualty Care and Exfil Planning09:59 Medical Supplies: Drugs, Medications, and Sterility10:42 Camp Craft and Bushcraft Skills for Remote Medics11:35 Wildcrafted Plants and Improvised Medicine12:12 Communication Strategies in Dense Canopy Environments13:08 Team Coordination and Role Assignments14:08 Dealing with Critical Patients and Exfil Decisions14:57 Infection Control and Hygiene in the Field15:54 Personal and Team Safety Measures16:39 Additional Non-Medical Gear for Remote Operations17:16 Lighting Solutions and Bug Management at Night18:08 Medications and Drugs for Jungle Medicine18:45 Over-the-Counter and Emergency Medications19:34 Special Considerations for Malaria and Vector-borne Diseases20:04 Infection Control and Hygiene Protocols20:56 Water Purification and Boiling Techniques21:35 Field Sterilisation and Maintaining Sterility22:25 Managing Glove Supplies and Hand Hygiene23:00 Dermatology and Common Skin Conditions23:38 Malaria Prophylaxis and Treatment Strategies24:32 Infection Control and Personal Hygiene25:14 Power and Charging Solutions in Remote Areas26:04 Water Supply and Filtration Methods26:45 Field Sterilisation and Water Boiling Techniques27:21 Camp Craft and Bushcraft Skills for Field Survival27:56 Wildcrafting and Medicinal Plants in the Jungle28:47 Communication Equipment and Strategies in Dense Canopy29:41 Team Coordination and Medical Decision-Making30:17 Water Safety and Potable Water Management31:05 Team Safety and Preventing Illness in the Field32:04 Bushcraft Skills for Remote Medical Operations32:58 Survival Skills and Improvised Medicine33:48 Communication Tools and Emergency Signalling34:28 Exfil Planning and Evacuation Protocols35:14 Prolonged Casualty Care and Equipment Needs36:01 Medical Kits and Supplies for Extended Operations36:51 Decision-Making in Critical Situations37:23 Non-Medical Essentials: Woobies, Tools, and Comfort Items38:10 Maintaining Morale and Team Cohesion38:42 Summary and Final Tips for Jungle ICU Setup

This week, Aebhric O'Kelly talks with Eirik Holmstrom about the newly updated MIC MEC and Pharm CPD courses, which have been combined into a new online CPD programme called 'Austere Primary Care.' This APC is a package that includes Disease and Non-Battle Injuries (DNBI) encountered on expeditions, in military operations, at remote clinical sites, and in resource-limited environments. You can find up-to-date information on our course webpage https://corom.moodlecloud.com/

This week, Aebhric O’Kelly talks with Dr Csaba Dioszeghy about the redesign and upgrade of the MSc Austere Critical Care programme. Every 5 years, the degree programmes undergo reaccreditation. The College has decided to double the programme's size following feedback from graduates. Chapters00:00 Introduction to the New Masters of Austere Critical Care Program01:03 The Complete Rehaul of the Curriculum01:57 Flexibility and Pathways in the New Program02:51 Comparison with UK Advanced Practice Programs03:46 Four Pillars of the New Curriculum04:41 Special Focus: Medical Support to Resistance Healthcare07:02 Innovations in Improvised Medicine08:21 Practical Modules: Ultrasound and Tropical Medicine09:44 Student Research and Thesis Projects11:30 Program Launch and Future Outlook

This week, Aebhric O’Kelly is joined by Splinter Knoppert, who is a 2nd-year BSc student attending the Intensive Care for Austere and Remote Environments (ICARE) course in Malta. They discuss his experiences during the week, including the practical skills, teamwork, resource-limited environments, and innovative teaching methods.Aebhric is then joined by Dr Csaba Dioszeghy, and they discuss the origin of the ICARE course 14 years ago. Chapters00:00 Introduction to the ICARE Course in Malta00:58 BSc Student Splinter talks about his experience in ICARE02:04 Diverse Participants and Their Backgrounds02:53 Skills Gained: Ultrasound, Central Lines, and Improvisation03:47 Blue Time: Practice and Muscle Memory05:06 Overview of Scenarios: Crush Injuries, Tropical Diseases, and Trauma05:52 Building a Remote ICU: Key Components and Challenges06:30 Setting Up an ICU in the Jungle: Precautions and Planning07:14 Impact on Paramedic Practice and Future Plans08:16 Introduction to Dr Csaba Dioszeghy and Critical Care Education09:06 Origins of Critical Care Teaching and Collaboration10:51 Simplifying Critical Care for Resource-Limited Settings13:07 Development of the MSc in Critical Care14:29 Teaching Principles: Using Critical Care Without Fancy Equipment15:26 From Aeromedical Transport to Specialised Critical Care Training16:22 Addressing the Gap in Critical Care Education16:47 Curriculum Focus: Basic to Advanced Critical Care Concepts17:43 Teamwork and Non-Technical Skills in Critical Care18:40 The Importance of Crew Resource Management20:20 Simulation-Based Training for Teamwork and Skills21:15 Elective Courses and International Participation22:10 The Future of the MSc Program and Crew Resource Management24:04 Technical Skills Practice: Ultrasound, Suturing, and Intubation24:57 The Value of the iCare Course and Its Evolution25:50 Upcoming Deep Dive into the Masters of Austere Critical CareWe will have questions about the episode icon, which is a picture of an ancient carving of the Rod of Asclepius. This is on a church outer wall in Mdina, Malta, with origins in the Knights Hospitaler.

This week, Aebhric O'Kelly and Bill Vasios host another CoROM Conversations. This month, they discuss the comprehensive nursing interventions, training strategies, and best practices for prolonged field care, emphasising simplicity, effective handovers, and patient safety.https://youtu.be/U63NaFLaxZ0Chapters00:00 Introduction to Nursing Interventions00:53 Exploring CPGs and Nursing Interventions02:25 Comparing Non-Medical and Medical Personnel Guidelines05:50 Simplifying Nursing Interventions for Non-Medical Personnel09:05 Wound Care Disparities in Guidelines11:05 Identifying Gaps in Nursing Care Guidelines12:07 The Need for Simplified Guidelines16:15 Importance of Structured Handover24:03 Trending and Serial Assessment in Patient Care26:17 Understanding Patient Comfort and Injury Prevention27:36 The Importance of Hands-On Nursing28:32 Pressure Injury Prevention Strategies29:52 Efficient Patient Care Techniques31:17 Pain Management in Nursing33:12 Pulmonary Hygiene and Patient Mobility35:14 Nutrition and Hydration in Patient Care35:37 The Role of Checklists in Medical Practice41:33 Infection Prevention and Wound Care43:34 Final Thoughts on Patient Care Practices44:01 Any Questions?

This week, Aebhric is joined by Dr Harrison Steins, who is finishing his MSc in Austere Critical Care with CoROM. He also finished medical school and is starting his emergency medicine training. His master’s thesis was on the complexities of swimming-induced pulmonary oedema (SIPE), a rare condition affecting athletes, particularly in high-altitude environments. The speaker, Harrison Steins, discusses the pathophysiology, clinical presentation, diagnosis, and management strategies for SIPE, emphasising the importance of context in medical practice. He shares case studies, research findings, and future directions for understanding and treating this condition, highlighting the role of ultrasound in diagnosis and the need for tailored prevention strategies.TakeawaysSwimming-induced pulmonary oedema is a rare condition with a prevalence of less than 1%.Understanding the context of patient presentation is crucial for diagnosis.Acute-onset cough and dyspnoea are key symptoms of SIPE.Diagnosis requires a broad differential, ruling out other conditions first.Management focuses on immediate life threats before addressing SIPE.Hydration strategies can prevent SIPE, especially in athletes.Sildenafil may be effective in preventing SIPE, but it is not widely recommended.Handheld ultrasound is a reliable tool for diagnosing pulmonary oedema in the field.Females may have a higher incidence of SIPE at lower elevations than males do.Knowledge of population-specific pathology is essential for effective treatment.Chapters00:00 Introduction to Swimming-Induced Pulmonary Oedema04:47 Understanding the Pathophysiology of Swimming-Induced Pulmonary Oedema09:18 Case Studies and Clinical Presentation13:48 Diagnosis and Imaging Techniques19:26 Management Strategies and Treatment24:17 Research Findings and Future Directions

This week, Aebhric O'Kelly interviews four students from our BSc in Remote Paramedic Practice programme. They discuss the Tropical Travel and Expedition Medical Skills course (TTEMS).

This week, Aebhric O'Kelly is joined by Dr Ella Corrick, Dr Sean Bilodeau and Dr Tom Mallinson as the CoROM faculty attend The Big Sick conference hosted by Air Zermatt. CoROM gave three lectures and two workshops including the Improvised Medicine workshop and the Austere Emergency Care workshop. TakeawaysThe challenge of compressing prolonged field care education into short workshops.Engagement of diverse professional backgrounds enhances learning experiences.Realistic simulations provide valuable insights into emergency care.The importance of bridging the gap between pre-hospital and hospital care.Innovations in emergency medicine practices are crucial for improving patient outcomes.Data plays a significant role in shaping emergency response strategies.Continuous education is essential for adapting to new medical practices.The value of informal discussions among professionals at conferences.Understanding the unique challenges faced by pre-hospital care providers.The need for a shift in perception regarding the role of EMS professionals.Chapters00:00 Introduction to the Big Sick Conference02:34 Challenges in Prolonged Field Care Education05:43 Diverse Professional Backgrounds in Medical Education08:09 Learning Through Realistic Simulations11:04 Bridging the Gap Between Pre-Hospital and Hospital Care13:39 Innovations in Emergency Medicine Practices16:46 The Role of Data in Emergency Response19:10 Future Directions in Pre-Hospital Care21:39 Conclusion and Reflections on the Conference

This week, we hear from Burjor Langdana, who runs the Wilderness and Expedition Dentistry workshop for CoROM. Burjor discusses the management of dental pain, focusing on assessing sensitivity, identifying causes, and evaluating treatment options. It emphasises the importance of patient care, oral hygiene, and antibiotic use in the management of dental conditions. The discussion also covers cultural considerations and improvisation in emergency situations, providing valuable insights for dental practitioners.https://wildernessdentistry.com/TakeawaysUnderstanding the characteristics of dental sensitivity is crucial.Location and duration of pain are key indicators.Aggressive brushing can lead to gum recession and sensitivity.Clove oil can be effective but should be used cautiously.Flossing is essential to prevent food buildup and gum irritation.Antibiotics may be necessary for managing infections.Improvisation is important in emergency dental care.Cultural beliefs can impact patient care and treatment acceptance.Communication with patients about procedures is vital.Managing expectations regarding treatment outcomes is essential.Chapters00:00 Introduction to Managing Dental Pain00:57 Understanding Sensitivity: Duration and Location06:32 Identifying Causes of Sensitivity12:12 Managing Sensitivity with Home Remedies12:40 Addressing Food-Related Pain18:37 Techniques for Filling Cavities29:11 Improvising Without Instruments29:39 The Role of Salt Water in Oral Health34:53 Managing Tooth Pain and Food Impaction39:06 Understanding Fillings and Their Complications45:42 Gumboils: Causes and Management49:48 Skills for Remote Dental Care56:04 Cultural Sensitivity in Dental Treatment

This week, Aebhric O’Kelly is again joined by Dr Sam Slishman. They discuss medical innovation and Aebhric’s invention called the AirBase. They discuss medical innovation, focusing on inventions, such as the Slishman Traction Splint and the Airbase. They emphasise the importance of evidence-based medicine, particularly in the use of tourniquets and bleeding control techniques. The discussion also addresses the challenges of marketing medical devices, the role of 3D printing in healthcare, and advice for aspiring medical professionals in austere environments.TakeawaysInnovations in medical devices can significantly impact patient care.Tourniquets are effective but should be used with caution.Direct pressure is often more effective than tourniquets for certain injuries.The Airbase serves multiple purposes during emergencies.3D printing can revolutionise medical device development.Standard of care is not static and can vary by location.Patient comfort is crucial in emergency medicine.Research in austere medicine faces unique challenges.Continuous learning and adaptation are essential for medics.Chapters00:00 Introduction to Dr Sam Slishman01:31 Innovations in Medical Devices04:25 Tourniquet Efficacy and Research09:38 Direct Pressure vs. Tourniquets17:50 The Airbase: A New Medical Tool24:14 Challenges in Medical Device Development31:20 The Role of 3D Printing in Medicine39:19 Advice for Aspiring Medics

This week, Aebhric O’Kelly is joined by Rabbit, who is an EU SOF medic who shares his extensive background in military medicine and his current focus on researching the effects of higher education on individuals with PTSD. He discusses his personal experiences with PTSD and how education has played a role in his recovery. The conversation also touches on the importance of engaging the younger generation in military medicine, adapting to the changing battlefield, and the need for collaboration between special operations and conventional forces. Rabbit emphasises the significance of education and teamwork in improving outcomes for those affected by trauma.TakeawaysRabbit has a rich background in military medicine and education.His PhD research focuses on PTSD and higher education.Education can provide hope and support for individuals with PTSD.There is a need for specialised programs for military personnel with PTSD.Engaging the younger generation is crucial for the future of military medicine.Collaboration between special operations and conventional forces is essential.Rabit emphasises the importance of teaching and enabling others in medicine.The battlefield is evolving with new technologies and challenges.Personal experiences with PTSD can inform research and treatment.Teamwork is vital in prolonged field care situations.Chapters00:00 Introduction to Rabbit and His Background02:52 Exploring PTSD and Higher Education10:22 Personal Experiences with PTSD and Education17:12 The Role of SOMA and Engaging the Younger Generation26:57 Advice for New Medics and Collaboration in Medicine

This week, Aebhric O’Kelly talks with Zach Andrews, a SOF medic, to discuss his journey through the MSc in Austere Critical Care, with a focus on his thesis on microcirculation in resource-limited settings. He shares insights into the challenges and learning experiences of his studies, the development of the AMSS score for assessing microcirculation, and his future aspirations in medicine, particularly in rural EMS and education.TakeawaysZach is on active duty in the U.S. Army as a SOF medic.He works as a critical care paramedic in a rural county.His thesis focused on microcirculation in resource-limited settings.He explored noninvasive methods for assessing microcirculation.Zach developed the mottling score to evaluate microcirculation.He emphasises the importance of basic medical skills.Zach plans to pursue a doctorate in the near future.He aims to validate his Microcirculatory Integrated Severity Scale (AMSS) in real-world settings.Zach believes in the significance of education in rural healthcare.He appreciates collaborative problem-solving in medical training.Chapters00:00 Introduction to Zach Andrews and His Journey06:08 Exploring the Master's Program in Osteo-Critical Care13:20 Thesis Topic: Microcirculation in Resource-Limited Environments20:24 Developing the Microcirculatory Integrated Severity Scale (AMSS)24:25 Future Plans and Advice for New Practitioners

This week, Aebhric O’Kelly, Bill Vasios, and Rhod Jordan lead an open discussion examining the critical role of nutrition in prolonged field care. The conversation explores enteral and parenteral feeding modalities, outlining their respective indications, benefits, and practical limitations in austere and resource-constrained environments. Particular emphasis is placed on the value of early nutritional intervention in supporting physiological recovery, including practical techniques for nasogastric tube placement and for identifying and managing feeding-related complications. The discussion further considers the challenges of maintaining nutritional support during patient transport. It highlights the importance of interdisciplinary collaboration, including consultation with nutrition specialists, to develop safe and effective nutritional care plans.TakeawaysNutrition is crucial in prolonged field care.Enteral nutrition is less invasive and safer.Early feeding improves healing and recovery.Consult a nutritionist for feeding plans.NG tubes can reduce complications in feeding.Monitor for complications during feeding.Parenteral nutrition may be necessary in some cases.Feeding techniques can vary based on patient condition.Understanding nutritional needs is essential for care.Future discussions will focus on advanced topics.Chapters00:00 Introduction to Prolonged Field Care and Nutrition02:40 Understanding Enteral and Parenteral Nutrition04:53 Benefits of Early Nutritional Support07:47 Indications and Contraindications for Feeding09:32 Practical Considerations for Feeding in Austere Environments11:51 Calculating Nutritional Requirements14:30 Challenges in Nutritional Support During Transport17:16 Techniques for NG Tube Placement20:00 Monitoring and Managing Feeding Complications22:19 Discussion on Parenteral Nutrition24:41 Conclusion and Future Topics

This week, Aebhric O’Kelly and Bill Vasios host an online discussion on the JTS sepsis CPG. CoROM students and members of the college join this live discussion about how to assess and treat the septic casualty in remote and austere environments. Chapters00:00 Introduction to C-Circulation Problems01:34 Understanding Sepsis and Its Management09:17 Early Warning Systems for Sepsis14:15 Clinical Acumen in Remote Care20:20 Monitoring and Assessing Patient Status27:52 Antibiotic Administration in Remote Settings33:02 Malaria Treatment Protocols37:33 Resuscitation Strategies for Sepsis42:52 Point of Care Ultrasound in Patient Monitoring48:12 Final Thoughts and Future TopicsYou can download the JTS CPG on Sepsis here. https://jts.health.mil/assets/docs/cpgs/Sepsis_Management_PFC_28_Oct_2020_ID83.pdf

This week, Aebhric O’Kelly, Bill Vasios, and Rhod Jordan will host an open discussion on managing austere burn patients, covering airway management, fluid resuscitation, infection control, and pain management. The speakers emphasise the complexity of burn cases and the importance of accurate assessment and treatment protocols. They also highlight the need for effective communication and patient involvement in care, as well as the use of innovative techniques like topical morphine for pain management.TakeawaysBurns are incredibly complicated, but they're complex patients.Managing an individual patient's airway has to be factored in.You want to protect and secure the airway and avoid obstructions.The goal is to achieve maximal accuracy in fluid resuscitation.You can infuse that fluid rectally if you don't have IV fluids.Prophylactic antibiotics are not indicated in burn patients.Topical morphine works really, really well for pain management.Involving the patient in their care has a positive effect.Infection control is the means of preventing infection.Burn management is more art than science.Chapters00:00 Introduction to Burns Management03:08 Airway Management in Burn Patients05:52 Assessing Burn Size and Fluid Resuscitation09:00 Fluid Administration Techniques11:38 Oral vs IV Resuscitation14:53 Monitoring and Adjusting Treatment17:36 Dynamic Management of Burn Patients25:18 Vital Signs Monitoring in Critical Care28:01 Continuous Assessment and Patient Management32:07 Patient Involvement in Vital Signs Monitoring35:10 Urine Output and Fluid Resuscitation41:33 Infection Control in Burn Management48:20 Pain Management Strategies in Burns

This is a brief introduction to the AI roundtable to be held at the Medicine in the Mediterranean conference, running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This is a brief introduction to the AI roundtable to be held at the Medicine in the Mediterranean conference, running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This is a short introduction to the two lectures that Dr Slaven Bajic will be giving at the Medicine in the Mediterranean conference running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This week, Aebhric is joined by Bill Vasios and Rhod Jordan, who recorded during the November 2025 CoROM Conversations. They discuss Practical Prolonged Casualty Care, a PDF from the US Military University, designed to equip lay responders with foundational skills for managing casualties over extended periods. The speakers underscore the critical role of clear communication, the value of structured training for non-medical personnel, and the practical relevance of the book’s guidance in real-world scenarios. They highlight the importance of engaging patients actively in their own care, as well as the inherent challenges associated with preparing laypersons for such responsibilities. Considerations of cultural context and the necessity of a collaborative, team-based approach to patient management are also brought to the forefront.TakeawaysThe book is designed for laypeople to understand basic medical care.Effective communication is crucial in patient care.Training non-medical personnel can enhance patient outcomes.Involving patients in their own care is beneficial.Cultural considerations play a significant role in patient care.The book provides practical techniques for prolonged casualty care.Regular assessment and monitoring are essential for patient safety.Lay responders should be trained to recognise nonverbal cues of discomfort.The importance of maintaining a regular routine for patients is emphasised.Cross-training team members can improve overall care.Chapters00:00 Introduction to Prolonged Casualty Care02:50 Deep Dive into the Book's Content06:04 Engaging Laypersons in Medical Care08:55 Communication and Patient Interaction11:37 Training Non-Medical Personnel14:49 Practical Applications and Techniques17:51 Understanding Patient Needs20:39 Challenges in Training and Implementation23:28 Cultural Considerations in Patient Care26:16 Conclusion and Future Directionshttps://www.usuhs.edu/sites/default/files/2025-09/Layperson%27s_Guide_to_Prolonged_Casualty_Care_090825_ACC.pdf

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at ⁠Medicine in the Mediterranean⁠, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum. Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at ⁠Medicine in the Mediterranean⁠, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum. Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at Medicine in the Mediterranean, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum.Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at ⁠Medicine in the Mediterranean⁠, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum. Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This week, Aebhric O’Kelly talks with Dr Chris Carter, a critical care nurse and academic, who shares his journey from military nursing to working in Zambia, where he has been instrumental in developing critical care nursing programs. He discusses the challenges and innovations in critical care nursing, particularly in resource-limited environments, and reflects on the impact of COVID-19 on the healthcare landscape. Dr Carter emphasises the importance of education, collaboration, and flexibility in nursing practice and offers advice for new professionals entering the field.TakeawaysDr Chris Carter transitioned from military nursing to academia.He is currently working in Zambia to enhance critical care education.COVID-19 highlighted the need for investment in critical care nursing.Collaboration with local stakeholders is crucial for program development.Innovations in critical care can improve patient outcomes.Education programs must be tailored to local needs and resources.There is a growing recognition of the importance of critical care nursing.Flexibility and adaptability are key in austere medical settings.Dr Carter advocates for updates to critical care nursing literature.New professionals should embrace every opportunity in their careers.Chapters00:00 Introduction to Dr. Chris Carter03:35 Journey to Zambia and Critical Care Education09:01 Developing Critical Care Nursing Programs12:34 The Impact of COVID-19 on Critical Care16:13 Innovations in Critical Care Nursing19:52 Future of Critical Care Nursing Education26:51 Advice for New Professionals in Austere Medicine

This week, Aebhric O’Kelly talks with Greydon Ratushny about his master’s thesis. He recently graduated from the MSc Austere Critical Care programme. They discuss the significant challenges faced in delivering quality healthcare in remote and rural areas of British Columbia. Greydon emphasises the critical role of pain management in improving patient experiences and outcomes, particularly in paramedic services. Ratushny highlights the immediate impact that effective pain management can have on patients and its importance in their overall healthcare journey.TakeawaysThere are significant challenges in delivering quality healthcare in rural areas.Pain management is a key focus for improving patient outcomes.An immediate impact on pain can enhance the patient experience.The quintuple aim concept is essential in healthcare delivery.Paramedics play a crucial role in managing pain effectively.Rural communities require tailored healthcare solutions.Understanding patient experiences is vital for healthcare improvement.Effective pain management can influence long-term patient recall.Healthcare delivery must adapt to the unique needs of remote areas.Research and innovation are needed to address rural healthcare challenges.Chapters00:01 – Introduction and guest welcome02:30 – ACC learning experience and placements06:15 – Motivation for choosing ACC09:50 – Curriculum gaps and collaboration13:55 – Programme redesign and electives15:40 – Thesis focus: austere nerve blocks20:10 – Scope of practice and POCUS24:30 – Pain management in prolonged transport29:40 – Rural healthcare equity challenges32:50 – Doctoral research ambitions35:40 – Advice to future candidates36:30 – Closing reflections

This week, Aebhric OKelly and Sam Coffman continue their discussion on the Guerrilla Medic and what to grow in their garden to supplement their ICU. Sam discusses the unique advantages of herbal remedies in treating viral infections. They discuss easy-to-find herbal medicine from your camp kitchen.TakeawaysHerbs can address specific health niches that pharmaceuticals cannot.Herbal formulas are effective for various viral infections.Herbs can help repair and restore tissue health.The mucosa and lymph movement are supported by herbal remedies.Herbs can slow down and stop virus shedding.Pharmaceuticals lack the holistic approach that herbs provide.Herbs can enhance the body's terrain for better health.Herbal remedies can be more effective in certain health conditions.The use of herbs can lead to better overall health outcomes.Understanding the unique benefits of herbs is crucial for health.Chapters00:00 Introduction to Medicinal Herbs10:46 Key Herbs for Upper Respiratory Health14:10 Herbs for Gut and Liver Support17:42 Common Kitchen Herbs to Support your ICU26:56 Honey as Medicine31:26 More Kitchen Herbs35:44 Improvised Medicine Workshop at SOMSA

This week, Aebhric and Sam continue their discussion of Medical Support for Irregular Warfare, specifically focusing on the use of the Guerrilla Garden. They discuss the unique advantages of herbal remedies compared to pharmaceuticals, particularly in treating viral infections. He highlights how herbs can effectively slow down virus shedding, repair tissue, and support overall health in ways that pharmaceuticals cannot.TakeawaysHerbs can address specific health niches that pharmaceuticals cannot.Herbal formulas are effective for various viral infections.Herbs can help repair and restore tissue health.Herbal remedies support the mucosal and lymphatic systems.Herbs can slow down and stop virus shedding.Pharmaceuticals lack the holistic approach that herbs provide.Herbs can enhance the body's terrain for better health.Herbal remedies can be more effective in certain health conditions.Using herbs can lead to better overall health outcomes.Understanding the unique benefits of herbs is crucial for health.Chapters00:00 Intro to Guerrilla Gardening and Nutrition01:48 Foraging and Wildcrafting for Food04:45 The Importance of Cooking Wild Foods07:33 Identifying Nutrient-Dense Plants10:06 Sprouting Seeds for Quick Nutrition13:06 Microgreens and Mushrooms as Food Sources16:17 Safe Mushroom Identification21:00 Planning for Sustainable Winter Nutrition24:27 Utilising Humanure for Soil Health26:04 Guerrilla Gardening Techniques33:37 Top Edible Plants for Guerrilla Medics

This week, Aebhric OKelly talks with Sam Coffman about the Guerrilla Medic and supplementing Medical Support for Irregular Warfare using locally procured plants. They discuss their training as Green Berets in MSIW and how the medic on the ground can learn and use plants to support the Guerrilla Clinic. This first episode lays the groundwork for this concept. They discuss the integration of herbal medicine with Western medical practices, emphasising the unique benefits of herbal formulas, particularly in treating viral infections and repairing tissue. The discussion highlights the potential of herbal medicine to address acute health issues where pharmaceuticals may fall short, and encourages practitioners to find specific niches where herbal remedies excel.Episode two drops next week and focuses on the use of plants to supplement the nutritional requirements for acute casualties and healthcare staff working in a hidden, remote clinic in semi-permissive environments. TakeawaysHerbs provide unique benefits that pharmaceuticals do not.Acute care is a significant area for herbal medicine.Finding niches for herbs can enhance treatment efficacy.Herbal medicine can complement Western medical practices.Viral infections can be treated with herbal treatments.Integrating herbal and Western medicine can support the Guerrilla clinic.Practitioners can easily master specific applications of herbs.Chapters00:00 Introduction to Herbal Medicine and Survival Gardening02:50 Sustainable Food Production in Crisis Situations05:38 Integrating Herbal Medicine into Resistance Healthcare12:16 Acute Care and Herbal Remedies14:28 Food Sources for Resistance Healthcare19:17 Foraging and Utilising Local Plants22:26 The Use of Alder and Medicinal Herbs24:45 Lessons from Guerrilla Medicine in WWII26:59 Building a Decentralised Medical System30:38 Wildcrafting: Harnessing Nature’s Pharmacy35:12 Creating a Learning Pathway for Remote Medics42:19 Integrating Herbal Medicine into Resistance Healthcare

This week, Aebhric OKelly talks with Eric Linder, who shares the inspiring journey of Team 5, an organisation dedicated to providing remote medical care in underserved communities. Starting as a small group of friends, Team 5 has evolved over 15 years, focusing on humanitarian work without political or religious affiliations. Eric discusses the importance of education and training in remote medicine, emphasising the need for adaptability and cultural understanding. He also offers valuable advice for aspiring remote medics, highlighting the significance of hands-on experience and proper education in making a meaningful impact in global health.TakeawaysTeam 5 started as a small group of friends wanting to help others.The mission evolved from Belize to Guatemala due to logistical challenges.Team 5 focuses on providing medical care without political or religious affiliations.The organisation has grown, but it aims to keep missions small and effective.Eric Linder integrates educational programs with practical missions for students.Remote medicine requires adaptability and understanding of local cultures.Training in remote medicine is essential for effective humanitarian work.Volunteering in underserved areas can provide valuable experience.Education in public health is crucial for addressing global health issues.Team 5 emphasises the importance of being prepared for challenging environments.Chapters00:00 The Birth of Team 513:16 Expanding Horizons in Remote Medicine26:53 Education and Training in Remote Medicine30:55 Advice for Aspiring Remote Medics

This week, Aebhric talks with Jason Jarvis, a former Special Forces medic and current PhD candidate, and discusses Chagas disease, a tropical disease transmitted by the kissing bug. He explains the life cycle of the bug, the transmission of the disease, its clinical presentation, and the challenges in diagnosis and treatment. The conversation emphasises the importance of awareness and preventive measures, especially as Chagas disease is spreading to new regions, including parts of the United States. The discussion concludes with key take-home messages for healthcare providers and the need for ongoing education in tropical medicine.TakeawaysChagas disease is transmitted by the kissing bug, primarily in Central and South America.The life cycle of the kissing bug involves several stages, including the transmission of the parasite through its faeces.Clinical diagnosis is essential, especially in endemic areas where the disease is prevalent.The acute phase of Chagas disease is easier to treat than the chronic phase, which can lead to severe complications.Preventive measures include avoiding exposure to kissing bugs and ensuring blood products are screened for the disease.Chagas disease can also be transmitted through blood transfusions and organ transplants.Healthcare providers should be aware of the symptoms and risk factors associated with Chagas disease.The disease is now spreading to parts of the continental US, raising public health concerns.Ongoing education and awareness of tropical diseases are crucial for healthcare providers.The conversation highlights the importance of understanding the global health implications of diseases like Chagas. Chapters00:00 Introduction to Chagas Disease and Its Relevance02:36 Life Cycle of the Kissing Bug and Transmission of Chagas Disease04:58 Understanding the Pathophysiology of Chagas Disease07:31 Clinical Presentation and Diagnosis of Chagas Disease10:18 Chronic Phase and Long-term Effects of Chagas Disease12:41 Treatment Options and Challenges in Managing Chagas Disease14:51 Preventive Measures and Risk Factors for Chagas Disease17:39 Chagas Disease in the Context of Global Health19:42 Take-Home Messages for Healthcare Providers22:20 Future Considerations and Closing Thoughts

This week, Aebhric talks with students from the University of Pavia in Italy who were attending the Austere and Prehospital Ultrasound course. They discuss innovative teaching methods of ultrasound in medical education, particularly focusing on peer-to-peer learning and the integration of ultrasound training with anatomy education. The students share their experiences with the CoROM ultrasound course, emphasising the practical approach that enhances their understanding of anatomy and clinical skills. They also discuss the challenges of implementing ultrasound training within the medical curriculum and the importance of hands-on experience in mastering ultrasound skills. The conversation highlights the need for supportive faculty and the potential for peer-to-peer teaching to improve learning outcomes in medical education.TakeawaysThe CoROM ultrasound course emphasises practical learning over theoretical knowledge.Peer-to-peer teaching enhances understanding and retention of ultrasound skills.Integrating ultrasound training with anatomy education provides a dynamic learning experience.Students benefit from hands-on experience in real clinical settings.Ultrasound is a skill-based tool that requires practice to master.The importance of having supportive faculty in implementing new teaching methods.Innovative teaching approaches can make learning more engaging and effective.Students are motivated to continue learning and teaching ultrasound skills.There is a need for a standardised curriculum for ultrasound training in medical education.Continuous assessment and practice are key to becoming proficient in ultrasound. Chapters00:00 Introduction to the Quorum Podcast and Course Overview01:04 Experiences with the Quorum Ultrasound Teaching Method03:26 Integrating Ultrasound with Anatomy Education06:29 Peer-to-Peer Teaching in Ultrasound Training08:53 The Role of Ultrasound in Clinical Education11:43 Challenges and Support in Implementing Ultrasound Training15:09 Innovative Teaching Approaches in Ultrasound Education17:57 Understanding Ultrasound Through Hands-On Experience19:53 Future Plans for Ultrasound Curriculum Integration23:43 The Importance of Peer-to-Peer Learning in Medicine26:51 Advice for Beginners in Ultrasound Training

This week, Aebhric talks with Andrew Azelton, a CoROM MSc student, discussing his journey through the EMS field and the challenges faced in pursuing advanced practice as a paramedic. He highlights the lack of master's programs in the U.S. that focus on clinical experience, contrasting it with the more developed systems in Europe. The discussion explores state regulations, the variability of care across different regions, and potential pathways for paramedics to advance their roles within the healthcare system.They explore the concept of an advanced practice paramedic, comparing EMS systems in the U.S. and Europe, discussing funding challenges, and the potential for creating new pathways for paramedics. It emphasises the need for advanced education and training, as well as the importance of funding in implementing changes in the EMS system. The discussion also touches on the future of paramedic education and offers advice for new medics entering austere medicine.TakeawaysAndrew Aselton is pursuing a master's program in EMS.The U.S. lacks master's programs focused on clinical experience for paramedics.The EMS system in the U.S. is fractured and varies by state.In Europe, paramedics have their own licenses and greater autonomy.State regulations have a significant impact on the practice of paramedics in the U.S.Advanced practice paramedics are emerging in some states, like Kentucky.There is a need for a structured pathway for advanced practice paramedics in the U.S.The conversation highlights the differences in EMS practices between the U.S. and Europe.Waving a magic wand could lead to significant changes in paramedic education.The discussion raises questions about the future of paramedics in advanced roles.An advanced practice paramedic should have field experience and a graduate degree.Hands-on learning and clinical attachments are crucial for paramedic education.The EMS system in the U.S. varies significantly by state and funding.Funding challenges hinder the implementation of advanced practice paramedics in the U.S.EMS is often not considered an essential service, which can impact funding and resources.Data shows that treatment release can save money and reduce hospital admissions.A national support system is needed for advanced practice paramedics.Creating a nurse practitioner pathway for paramedics could be beneficial.Funding disparities exist between tax-based and for-profit EMS systems.New medical professionals should seek appropriate training and be prepared for the challenges of working in austere environments.Chapters00:00 Introduction to Andrew Aselton and His Journey02:37 Challenges and Growth in the Master's Program05:10 The State of EMS Education in the U.S.07:47 Advanced Practice Paramedics: A Path Forward10:41 The Future of EMS and Advanced Practice Opportunities12:00 Designing the Advanced Practice Paramedic14:52 Comparing EMS Systems: U.S. vs Europe18:00 Funding Challenges in EMS21:50 The Role of Advanced Practice Providers24:08 Creating a New Pathway for Paramedics29:59 The Future of Paramedic Education32:59 Advice for New Medics in Austere Medicine

This week, Aebhric OKelly speaks with Giuseppe Mercieca, the CoROM student representative. They discuss his role as a student advocate, the importance of improvisation in medical training, and the college's future aspirations. The conversation also touches on student feedback, career pathways for paramedics, and advice for new students considering a paramedic program.TakeawaysGiuseppe is a bachelor's student preparing for his clinical placement.He aims to improve communication and support for students.High-fidelity scenarios enhance learning experiences.Improvised medical techniques are crucial in austere environments.Student feedback is essential for program development.Career opportunities exist in remote and offshore medical positions.Networking and volunteering are key to finding jobs.The college is expanding programs based on student demand.CPD courses can serve as an introduction to the program.Collaboration with other medical professionals is vital for progress.Chapters00:00 Introduction to Eye Care Course in Malta02:29 Role of Student Representative05:09 Improvised Medical Techniques07:20 Future Aspirations for the College09:27 Student Feedback and Engagement11:55 Career Pathways for Paramedics14:24 Advice for New Paramedic Students

In this episode, host Aebhric O’Kelly kicks off the new academic year and reflects on the growth of the College of Remote and Offshore Medicine (CoROM), which will celebrate its 10-year anniversary next year. What began in 2016 with just 16 students has grown into an international institution with over 100 students across four degree programmes.This episode features conversations with the leaders of CoROM’s three postgraduate programmes:Dr Ella Corrick – Director of the Doctorate in Health Sciences (DHS), who discusses the growth of the doctoral cohort, the possibility of transitioning to a PhD programme, and the vital role of building a strong online academic community.Dr Csaba Dioszeghy – Programme Manager of the MSc in Austere Critical Care (ACC), who shares upcoming updates, including flexible online pathways, new elective modules in ultrasound and paediatric critical care, and stronger international clinical placement partnerships.Dr Nick Zuber – Programme Director of the Masters in Global Health (MGH), who explains the difference between global and public health, the diverse career opportunities for graduates, and how this degree prepares clinicians for leadership roles in international healthcare systems and disaster relief.

This week, Aebhric OKelly talks with Pierto Batistoni, Grant Hollyoake, and Finn McNamara, who are currently going through the BSc Remote Paramedic Practice programme. They explore the experiences of paramedic students during their clinical placements in Tanzania, focusing on their integration with local medical staff, the challenges they face in emergency medicine, and the unique medical cases they encounter, particularly related to altitude sickness. The students share insights on their learning experiences, the skills they are developing, and the cultural aspects of living and working in Tanzania. They also discuss the importance of building relationships with local healthcare professionals and the impact of their experiences on their future careers in medicine.TakeawaysThe integration with local staff enhances learning and trust.Emergency medicine in Tanzania presents unique challenges.Improvised medical solutions are often necessary in resource-limited settings.Altitude sickness is a common issue for climbers on Kilimanjaro.Building relationships with local healthcare professionals is crucial.Clinical placements provide hands-on experience in real-life scenarios.Students experience a wide range of medical cases during their placements.Cultural experiences enrich the overall learning process.Living conditions can vary, impacting student experiences.Advice for future students includes joining local networks for support.Chapters00:00 Introduction to Clinical Experiences in Tanzania01:59 Diverse Backgrounds and Initial Challenges04:16 Integration with Medical Staff06:12 Experiences in the Emergency Department07:46 Improvised Medical Practices09:54 Common Injuries and Case Studies12:08 Altitude-Related Illnesses14:51 Clinical Skills and Learning Opportunities20:21 Living Conditions and Accommodation24:34 Leisure Activities and Cultural Experiences27:17 Advice for Future Students

This week, Aebhric O’Kelly talks with Jonathan Downham, an advanced critical care practitioner, who shares his journey and insights into the evolving role of advanced practitioners in healthcare. He discusses the training pathways, responsibilities, and the importance of collaboration with junior doctors. Jonathan emphasises the need for continuous learning, research opportunities, and the future of advanced practice in critical care. He also highlights his innovative approach to training through e-learning and podcasts, aiming to enhance the skills of healthcare professionals.TakeawaysJonathan Downham is an advanced critical care practitioner with extensive experience in nursing.The role of advanced critical care practitioners (ACCPs) is to provide consistency in critical care units.ACCPs are trained to perform many tasks traditionally done by junior doctors, enhancing patient care.Training for ACCPs includes a postgraduate diploma and a master's degree, focusing on clinical skills and research.ACCPs have their own license to practice and can prescribe medications independently.The role of ACCPs is evolving, with opportunities in research and education.There is a growing recognition of the value of ACCPs in the healthcare system.The future of ACCPs may involve more independence and leadership roles in healthcare.Jonathan has created an e-learning platform to enhance training for critical care practitioners.Continuous learning and curiosity are essential for success in healthcare.Chapters00:00 Introduction to Advanced Critical Care Practice04:34 The Role of Advanced Critical Care Practitioners09:09 Training Pathways and Qualifications14:06 Independence and Responsibilities of ACCPs19:44 Research and Publication in Advanced Practice26:40 Future of Advanced Critical Care Practitioners29:21 Creating Educational Resources for Critical Care33:22 Advice for New Practitioners

This week, Aebhric talks with Mark Lopshire, who shares his extensive experience in humanitarian medical support, particularly in crisis zones. He discusses the challenges faced in providing medical care in conflict areas, the innovative solutions developed in austere environments, and the importance of training in wilderness medicine. Mark emphasises the need for flexibility and cultural understanding when working in diverse settings, and he highlights the role of organisations like the Wilderness Medical Society in advancing the field of wilderness medicine.TakeawaysMark Lopshire has a diverse background in the military and medical fields.He is involved with an NGO that provides medical support in crisis situations.The organisation deploys quickly to areas affected by disasters or conflict.Medical care in austere environments requires improvisation and innovation.Local economies are supported by purchasing supplies locally when possible.Flexibility and patience are crucial for medical professionals in crisis zones.Wilderness medicine training is essential for effective practice in remote areas.Cultural understanding is vital when working with diverse populations.The Wilderness Medical Society offers valuable resources for practitioners.Mark encourages new practitioners to embrace challenges and learn from experiences. Chapters00:00 Introduction to Mark Lopshire and His Background03:09 Wilderness Medical Society's Role in Crisis Response05:50 Experiences in Ukraine and International Medical Support08:59 Challenges of Providing Medical Care in Conflict Zones11:40 Innovative Solutions in Austere Environments14:09 Haiti: Lessons from a Major Earthquake Response16:54 Getting Involved in Humanitarian Medical Efforts19:50 The Wilderness Medical Society and Its Importance22:48 Fellowship in Wilderness Medicine: Benefits and Opportunities25:42 Future Aspirations and Advice for New Medical Professionals 32:36 Advice for newly qualified

This week, Aebhric O’Kelly talks with Dr. Andrew Blaikie and Dr Helena Feasey, from St Andrews University in Scotland. They discuss the ArcLight device, a revolutionary tool designed for eye and ear examinations in low-resource settings. They share insights into the device's features, its development journey, and its potential impact on global health. The discussion highlights the importance of training healthcare workers, the device's telemedicine capabilities, and ongoing research aimed at reducing preventable blindness and deafness in communities worldwide.TakeawaysThe ArcLight device is a portable eye and ear examination tool.It uses solar power and is designed for low-resource settings.The device has been in development for over a decade.It allows healthcare workers to perform comprehensive examinations.The device is robust and can withstand harsh conditions.Telemedicine capabilities enhance its utility in remote areas.Research shows it is clinically equivalent to traditional devices.Training programs are essential for effective implementation.Future research aims to reduce preventable blindness and deafness.The ArcLight project collaborates with various NGOs globally.Chapters00:00 Introduction to ArcLight and Its Creators03:32 The ArcLight Device: Features and Benefits08:49 Clinical Applications and Telemedicine Potential14:06 Research and Development of ArcLight18:58 Future Directions and Community Impact

This week, Aebhric O’Kelly talks with Tim Cranton, who shares his experiences as an offshore medic, detailing a challenging patient case involving dental pain and the complexities of providing care in a remote setting. He discusses the importance of proper patient management, the challenges of medication availability, and the need for improved training in offshore medical practice. Tim emphasises the significance of networking and continuous education for aspiring offshore medics, as well as the potential for developing specialised courses in dental care for medics working in remote environments.TakeawaysTim Cranton is an experienced offshore medic with a background in global health.Managing patients in remote settings requires careful observation and assessment.Antibiotic stewardship is crucial in offshore medical practice.Pain management is a key aspect of treating dental emergencies.Communication with topside medical services is essential for patient care.Remote healthcare often involves waiting for transport due to weather conditions.Continuous education and training are vital for offshore medics.Networking is important for career advancement in offshore medicine.There is a need for more specialised training in dental care for medics.Tim advocates for the development of a dedicated offshore medics course. Chapters00:00 Introduction to Offshore Medicine26:37 Challenges in Remote Healthcare35:19 Future of Offshore Medic Training

This week, Aebhric O’Kelly talks with James Brogan, a UK paramedic and lecturer at Robert Gordon University, who discusses the unique challenges and opportunities in paramedicine, particularly in rural and remote areas of Scotland. He emphasises the importance of practice-based learning, the role of paramedics in public health, and the evolution of paramedic education towards a more academic and professionalised approach. Brogan also highlights the significance of decision-making skills in austere environments and offers advice for new paramedics entering the field.TakeawaysJames Brogan is a principal lecturer of paramedicine at Robert Gordon University.The university focuses on rural and remote paramedicine education.Practice-based learning is crucial for paramedic training.Paramedics play a significant role in public health initiatives.Austere medicine requires unique skills and decision-making abilities.The evolution of paramedic education has led to a more academic approach.Professionalisation of paramedics is essential for adapting to healthcare needs.Future paramedics will need to be versatile in various environments.Decision-making is more critical than just technical skills.New paramedics should focus on evidence-based practice and holistic care.Chapters00:00 Introduction to Paramedicine in Scotland02:22 The Unique Challenges of Rural and Remote Paramedicine04:56 Practice-Based Learning and Its Importance07:54 The Role of Paramedics in Public Health10:13 Austere Medicine and Prolonged Field Care13:05 The Evolution of Paramedic Education15:32 The Professionalisation of Paramedicine18:17 The Future of Paramedicine20:55 Advice for New Paramedics23:29 Conclusion and Reflections on Paramedicine

This week, we have another presentation from the Medicine in the Mediterranean conference from January 2025. Dr Matt Moront is a pediatric surgeon who provides an in-depth exploration of pediatric trauma care, emphasising the unique anatomical and physiological differences in children compared to adults. The speaker discusses common pediatric injuries, particularly in urban settings, and highlights the importance of airway management, weight estimation for medication dosing, and recognising signs of shock. Techniques for intubation and intravenous access in children are also covered, along with concerns regarding radiation exposure in pediatric imaging. The session concludes with key takeaways for healthcare providers working with pediatric patients.TakeawaysAirway management is critical in pediatric patients.Children are not just smaller adults; they have unique anatomical differences.Most pediatric trauma cases involve motor vehicle accidents and falls.Weight estimation is crucial for medication dosing in children.Children can maintain blood pressure until a significant volume of blood is lost.Intubation in children requires specific techniques and considerations.Radiation exposure in children should be minimised due to their sensitivity.Pediatric patients often present differently than adults in shock situations.Using the right size equipment is essential for pediatric care.Clinical indicators of shock in children are often visual rather than reliant on technology.Chapters00:00 Introduction to Pediatric Trauma Care02:40 Understanding Pediatric Injuries in Urban Settings05:23 Anatomical and Physiological Differences in Children08:34 Airway Management in Pediatric Patients11:21 Weight Estimation and Medication Dosing for Children14:12 Assessing Pediatric Vital Signs and Shock Indicators16:54 Intubation Techniques and Considerations for Children20:08 Practical Tips for Pediatric Emergency Care25:55 Intubation Techniques for Pediatric Patients29:00 Medications in Pediatric Intubation33:57 IV Access in Children40:00 Radiation Considerations in Pediatric Care

This week, Aebhric O’Kelly talks with CoROM student Dmitry Vosnyak, who shares his experiences as a remote paramedic student currently completing clinical placements in Kilimanjaro, Tanzania. He discusses his background in emergency medicine, the challenges faced in chaotic environments, and the importance of practical training alongside theoretical knowledge. Dmitry reflects on a mass casualty incident he encountered, emphasising the need for effective pre-hospital care and communication. He also shares insights on how to prepare for such situations and his aspirations for further education in critical care.TakeawaysDmitry has extensive experience as a paramedic in various settings.Studying alongside practical experience enhances learning.The chaotic environment in emergency medicine requires adaptability.Mass casualty incidents highlight the need for pre-hospital care.Preparation and communication are crucial in emergencies.Dmitry emphasises the importance of hands-on training.He values the connections made with local medical teams.Continuous learning is essential for paramedics.Dmitry aims to improve his skills in critical care.He encourages new paramedics to study and gain practical experience.Chapters00:00 Introduction to Dmitry Vosnyak's Journey04:50 The Importance of Practical Training10:53 Clinical Placements and Skill Development17:35 Mass Casualty Incident Experience23:55 Reflections on Improvement and Preparation30:37 Future Aspirations in Critical Care43:03 Advice for new paramedics

This week, Dr. Slaven Bajic we have another presentation from our Medicine in the Mediterreanean conference from January 2025. In this lecture, Slaven discusses the importance of ultrasound in pre-hospital settings, its advantages, limitations, and a case study demonstrating its application in trauma care. The discussion emphasises the need for clinical judgment alongside ultrasound findings and the growing role of ultrasound in modern emergency medicine.TakeawaysFocused ultrasound is revolutionising emergency medicine.The FAST protocol is essential for trauma assessment.Ultrasound can be more effective than traditional methods.Rapid identification of unstable patients is critical.FAST exams must be repeated to ensure accuracy.Ultrasound is a non-invasive and portable technology suitable for field use.Clinical judgment is crucial when interpreting FAST results.Ultrasound can facilitate prompt decision-making in emergency situations.Training and practice are vital for effective ultrasound use.Ultrasound technology is becoming indispensable in emergency settings.Chapters00:00 Introduction to Focused Ultrasound in Emergency Medicine02:27 Understanding the FAST Protocol04:40 Advantages of FAST in Pre-Hospital Settings07:28 Limitations and Challenges of FAST09:49 Case Study: Application of FAST in Trauma17:32 Conclusion and Future of Ultrasound in Emergency Medicine