Advertise on podcast: CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.

This week, Aebhric O'Kelly speaks with John Crofts, a nurse working at Zuckerberg San Francisco General Hospital, the city's Level I trauma centre. John brings an extraordinary perspective to austere medicine, combining emergency nursing, humanitarian logistics, infectious disease research and international humanitarian advocacy. Chapters 00:00 – Introduction: Meet John Crofts, emergency nurse and humanitarian advocate. 00:46 – Nursing at San Francisco General: Working in a Level I trauma centre. 02:10 – Violence and Burnout in Emergency Departments: A pilot programme addressing patient agitation and healthcare worker wellbeing. 04:14 – When Violence Compromises Critical Care: How competing demands divert resources from critically ill patients. 06:19 – Healthcare Violence and Ebola: Parallels between American emergency departments and humanitarian responses in resource-limited environments. 08:38 – When Patients Lose Trust in Healthcare: Inequality, frustration and violence against healthcare workers. 09:20 – Why Study Austere Medicine?: John's interest in CoROM and international humanitarian medicine. 10:16 – Humanitarian Logistics and Advocacy: Learning from clinicians working in Somalia, Ukraine and other challenging environments. 11:20 – The ICARE Experience in Malta: What John gained from the course. 12:19 – Learning from Other Clinicians: Scenario-based training, shared experience and challenging clinical assumptions. 14:31 – Bringing Austere Medicine Back to San Francisco: Why experienced emergency nurses can benefit from resource-limited training. 16:56 – Gunshot Wounds Outside the Hospital: When critical care begins on the street with minimal resources. 18:28 – An Unconventional Journey into Nursing: How John found his way into healthcare. 19:15 – From Helicopter Pilot to Humanitarian Logistics: Aviation, maritime operations and the importance of logistics. 20:41 – Nursing Education in Micronesia: Training at a hospital in Palau. 23:00 – Refugee Advocacy in Palau: Working with displaced Uyghur former Guantánamo detainees. 24:00 – Clearing Explosive Remnants of War: Humanitarian demining and environmental hazards in the Pacific. 25:20 – From Alaska to Austere Medicine: How John's experiences shaped his clinical and humanitarian interests. 26:55 – Studying Infectious Disease: The London School of Hygiene & Tropical Medicine and global health research. 27:30 – Sierra Leone After Ebola: Questions about outbreak preparedness and the sustainability of international aid. 28:51 – What's Next for John?: Returning to humanitarian work and strengthening healthcare systems. 30:00 – Bioethics and Global Health: Ethical challenges involving technology, resource allocation and healthcare inequality. 31:01 – Humanitarian Medicine Beyond Academia: Why practical advocacy remains important. 33:26 – Humanitarian Work in Myanmar: Landmines, local communities, political pressures and deportation. 35:39 – Research, Publications and Advocacy: Sharing lessons from humanitarian practice. 36:28 – Advice for New Austere Clinicians: Following an unconventional career path and embracing uncertainty. 38:32 – Compassionate Care in Challenging Systems: Why healthcare professionals must advocate for patients and meaningful change. 39:15 – Closing Thoughts: The importance of learning, professional relationships and returning to Malta.

This week, Aebhric O’Kelly catches up with Dmytro following his graduation from CoROM’s BSc in Remote Paramedic Practice and his successful registration as a paramedic with the UK Health and Care Professions Council (HCPC). Dmytro describes his current work providing medical care on a remote Caribbean island and reflects on previous roles in humanitarian and military medicine in sub-Saharan Africa. He explains why working remotely requires a different clinical mindset—particularly when weather, geography or resources prevent evacuation, and a patient may remain in your care for hours or even days. Chapters 00:00 – Welcome Back, Dmytro: From CoROM graduate to HCPC-registered paramedic. 00:33 – Remote Medicine in the Caribbean: Providing healthcare for thousands of guests and staff on a private island. 01:30 – An ICU on a Remote Island: Ventilation, capnography, laboratory diagnostics, POCUS and advanced monitoring. 02:58 – Paramedics Doing Radiography: The expanding role of the remote paramedic. 03:18 – From Africa to the Caribbean: Humanitarian medicine, military medicine and remote clinic operations. 04:40 – Qualifications for Remote Paramedic Work: How education and operational experience helped Dmytro secure his current position. 05:33 – Why CoROM?: Why one year of paramedic education wasn't enough and why Dmytro continued through the full BSc. 07:20 – Becoming a UK-Registered Paramedic: Starting the HCPC international registration process. 09:27 – HCPC Standards of Proficiency: Demonstrating education, experience, autonomy and clinical competence. 11:36 – Lessons from the HCPC Application: Documentation mistakes that can add weeks or months to the process. 13:58 – AI, Plagiarism and HCPC Applications: Why applicants need to ensure their submission is genuinely their own work. 14:15 – The First HCPC Assessment: Where additional evidence was required. 15:58 – Preparing for the Test of Competence: UK clinical guidance, common conditions and targeted preparation. 18:17 – UK Law and Paramedic Practice: Consent, safeguarding, mental capacity, resuscitation and verification of death. 18:50 – What Happens During the Test of Competence?: Clinical scenarios and assessment by practising NHS paramedics. 20:38 – Finally Registered: Completing an eight-month HCPC journey. 21:31 – What This Means for CoROM Graduates: Dmytro's pathway as a BSc Remote Paramedic Practice graduate. 22:03 – Graduation and the People Behind the Degree: Recognising the instructors and clinicians who shape a paramedic. 23:21 – Advice for Future BSc Students: Patience, practical training and making the most of KCMC. 25:09 – What Comes After the BSc?: MSc Austere Critical Care, offshore medicine and diving medicine. 26:19 – Does Austere Training Change How You Practise?: Why remote medicine requires a different professional perspective. 26:39 – Hospital Skills vs Remote Skills: Lessons from military medicine in sub-Saharan Africa. 28:29 – When You Cannot Evacuate: Managing patients for hours or days aboard ships and in remote locations. 29:40 – What Would Dmytro Do Differently?: More pharmacology, more KCMC and more exposure to ICU practice. 30:46 – Hurricanes, No Helicopter and No Boat: Why remote clinicians need critical care skills when evacuation fails. 31:40 – Advice for New Austere Clinicians: Learn remote medicine from people who actually work in resource-limited environments. 32:45 – Looking Back on the Journey: From student to degree-qualified, HCPC-registered remote paramedic. 32:56 – Acknowledgements: Dmytro thanks the CoROM faculty, colleagues and organisations that supported his journey. 34:20 – Closing Remarks: Continuing the journey in austere and remote medicine.

This week, Aebhric O’Kelly is joined by Rob Schembri, a Canadian critical care paramedic with Ornge, Ontario’s air ambulance service, and a student on CoROM’s MSc in Austere Critical Care. Rob discusses his journey through critical care paramedicine, his recent move onto a special operations team and why, after decades in the profession, he decided to pursue postgraduate education in austere medicine. His new role includes supporting the transport of patients with high-risk pathogens and mechanical cardiac support, as well as USAR and other specialist operations. The conversation explores the Canadian paramedic system, including the progression from Primary Care Paramedic to Advanced Care Paramedic and ultimately Critical Care Paramedic. Rob explains the extensive training required at the critical care level and how international paramedics can enter the Ontario system. Rob also talks candidly about undertaking his first research project, navigating ethics approval and discovering that the thesis he initially dreaded has become one of the most interesting parts of his MSc. The episode finishes with a discussion about lifelong learning, career development and Rob’s advice to clinicians beginning a career in austere medicine: learn as much as you can, experience as much as you can—and enjoy what you do. Chapters 00:00 – Meet Rob Schembri: Critical care paramedicine, Ornge and joining the special operations team. 01:18 – The Malta Connection: Rob's Maltese heritage and his family's move to Canada. 03:03 – Returning to Malta for a Master's Degree: The irony of pursuing postgraduate education in the country his parents left. 03:25 – Why the MSc in Austere Critical Care?: Preparing for specialist critical care and special operations. 05:02 – High-Risk and Special Operations Medicine: High-risk pathogens, mechanical cardiac support, USAR and specialist transport. 06:50 – Why Study Austere Critical Care in Malta?: Choosing CoROM rather than a conventional Canadian critical care programme. 08:18 – POCUS and Future Training: Bringing austere prehospital ultrasound into specialist practice. 11:05 – Reaching the MSc Thesis: Rob's progress through the programme. 11:36 – Researching Cognitive Load in Austere Conditions: Identifying a gap in conventional critical care paramedic training. 13:32 – Designing the Research: Comparing conventional scenarios with scenarios incorporating austere stressors. 15:02 – From Dreading Research to Enjoying It: Becoming a first-time clinical researcher. 16:01 – Research Ethics: The challenges of preparing an ethics submission. 17:42 – Why an MSc Should Include Research: Thesis versus coursework and what it means to earn a Master of Science. 19:42 – What Comes After the MSc?: PhDs, lifelong education and knowing when to give the family a break. 20:32 – Taking a Maltese MSc Back to Canada: Recognition, professional development and teaching opportunities. 22:31 – How Canadian Paramedicine Works: PCP, ACP and Critical Care Paramedic pathways. 24:43 – Moving Between Canadian Provinces: Reciprocity and employment across provincial systems. 25:40 – Is There a Canadian Paramedic Registry?: How Ontario regulates and identifies paramedics. 26:59 – International Paramedics Coming to Ontario: Where UK, Australian, South African and other clinicians may fit. 28:09 – Comparing US and Canadian Paramedic Education: Training pathways and entry into critical care practice. 30:06 – Becoming a Critical Care Paramedic in Ontario: The 16–18-month training process and clinical placements. 31:17 – “It's Never Too Late”: Rob became a critical care paramedic in his fifties. 32:04 – What Would Rob Do Differently?: Looking back on the MSc and a 36-year career. 32:54 – Advice for the Next Generation: Learn, experience, enjoy your work and value the people around you. 33:53 – Coming Home to Malta: Pastizzi, cannoli and plans to finally meet in person.

In this episode of the CoROM Podcast, Aebhric O'Kelly speaks with Kevin Fox, a Belgian EMT, maritime security professional and recent graduate of CoROM's BSc in Remote Paramedic Practice. Kevin's journey into medicine began following the 2016 Brussels terrorist attacks. Working in security at the time, he realised he lacked the medical knowledge to help casualties in a similar emergency. That experience eventually led him through tactical medical training, Belgian EMT education and CoROM's three-year degree. Kevin discusses his clinical placements in South Africa and Suriname, where he gained experience managing polytrauma, paediatric emergencies, childbirth and tropical infectious diseases. He describes how resource limitations challenged him to improvise, adapt and develop clinical judgement while working alongside local medical teams. The conversation then turns to tropical medicine in Europe. Kevin shares two memorable ambulance cases involving patients returning from India and Italy, explaining how a detailed travel history helped him recognise possible malaria and dengue. These experiences inspired his proposed research into incorporating recent travel more explicitly into prehospital patient assessment. Kevin also discusses his dissertation on Belgium's dengue preparedness, the importance of community education and his plans for further research and postgraduate study. Finally, he reflects on his three years at CoROM, the value of supervised clinical placements and the importance of recognising one's limitations. His advice to clinicians entering remote medicine is simple: test your equipment, remain self-critical and never become a toxic leader. 00:00 – Introducing Kevin Fox: From maritime security to remote paramedicine. 01:04 – The Brussels Terrorist Attacks: The event that inspired Kevin to pursue medical training. 03:05 – Why a Bachelor's Degree?: Professional development and European academic recognition. 04:30 – Future Academic Ambitions: Tropical medicine and postgraduate opportunities. 06:34 – Clinical Placements in Suriname: How TTEMS prepared Kevin for remote clinical practice. 08:35 – Why Suriname?: Language, culture and healthcare challenges. 10:30 – Working in a Surinamese Emergency Department: Trauma assessment and growing clinical responsibility. 13:12 – Memorable Clinical Cases: Polytrauma, paediatric emergencies and delivering a baby. 14:54 – Tropical Diseases in Suriname: Dengue, chikungunya and patients presenting with sepsis. 16:51 – Knowing Your Limitations: Clinical supervision, teamwork and asking for help. 20:10 – Three Years at CoROM: Practical training, student experiences and suggestions for improvement. 23:11 – Advice for First-Year Students: Why anatomy and physiology matter later in clinical practice. 25:28 – Kevin's Dissertation: Dengue preparedness and the establishment of tiger mosquitoes in Belgium. 28:44 – The Importance of Travel History: Recognising malaria in a patient returning from India. 30:00 – Could It Be Dengue?: A patient returning from Italy challenges clinical assumptions. 32:01 – The SAMPLER Research Project: Investigating tropical fever recognition among Belgian ambulance personnel. 33:48 – Tropical Medicine in Europe: Why clinicians need to consider emerging and imported infections. 35:19 – UK Paramedic Registration: Kevin's professional plans after graduation. 36:05 – Maritime and Offshore Medicine: Combining paramedicine with maritime security. 37:05 – Continuing Education: Tropical medicine, clinical laboratory skills and professional networks. 39:02 – Advice for Austere Clinicians: Never assume, remain self-critical and avoid toxic leadership. 40:25 – Closing Remarks. Chapters

In this episode of CoROM Conversations, Bill Vasios is joined by Dr Bob Dichiera, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University's PA programme. Bob introduces a practical approach to remote orthopaedics built around four questions: Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation? The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated pulse, motor and sensory (PMS) assessment before and after interventions. Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise. The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments. 00:00 – Tuning-fork fracture diagnosis cold open 00:18 – Introduction to Remote Orthopaedics 01:58 – Why MSK injuries matter in remote medicine 03:00 – Orthopaedic emergencies you cannot miss 04:18 – Damage-control orthopaedics 05:00 – Is the patient dying? Is the limb dying? 06:42 – Closed tibial fractures 07:40 – Diagnosing fractures with a tuning fork 09:06 – Splinting and traction decisions 11:31 – Compartment syndrome 14:00 – Pain with passive stretch 15:30 – Open fractures 16:20 – Irrigation 17:00 – Antibiotics for open fractures 21:06 – Field splinting and improvised splints 23:30 – Shoulder dislocations 25:55 – Shoulder reduction techniques 28:21 – Immobilisation and rehabilitation 30:45 – When should remote clinicians reduce a dislocation? 33:07 – PMS and neurovascular assessment 34:00 – Knee dislocations 35:35 – The easily missed vascular injury 37:56 – Reduction, ABI and evacuation 38:45 – Ankle injuries and Ottawa Ankle Rules 40:20 – Why weight-bearing does not exclude fracture 42:00 – Hand and wrist injuries 42:43 – Pelvic fractures 44:00 – Pelvic binders and avoiding repeated pelvic assessment 45:30 – Haemorrhage and pelvic trauma 46:00 – Pelvis versus femoral neck fracture 47:30 – Ultrasound in remote orthopaedics 47:50 – Should remote clinicians perform fasciotomies? 48:30 – Telemedicine and remote procedural guidance 49:53 – Closing

This week, Aebhric O'Kelly speaks with Dr Travis Kaufman and they explore his 25-year US Army career, his transition from combat engineer and military diver to Physician Assistant (PA), and five years providing medical support through the White House Medical Unit. Travis describes one of the most difficult lessons emerging from Ukraine: prolonged tourniquet use. A Ukrainian medic explains the decision as “triage of the limb or the life” when attempting tourniquet conversion after several hours may place the casualty at considerable risk. The discussion examines unnecessary tourniquet use, the importance of reassessment, contaminated wounds and the increasing problem of sepsis when evacuation is delayed for hours or days. Travis argues that the traditional TCCC assumption of rapid evacuation can create a training scar when casualties instead remain with combat lifesavers and medics for prolonged periods. The episode then explores what PCC actually looks like in practice: trending observations, wound debridement, antimicrobial planning, pain management, positioning, pulmonary care and the fundamental nursing interventions that can determine whether a casualty deteriorates. Travis also shares examples of improvisation from the field, including improvised PEEP and wound-vacuum techniques, and discusses why clinicians need to rediscover simple solutions when sophisticated equipment is unavailable. Chapters 00:00 – Meet Dr Travis Kaufman: From Army diver to PA, White House medicine and Ukraine. 02:26 – Becoming a Military Deep-Sea Diver: Training, attrition and operational diving. 06:12 – From Diver to Physician Assistant: Changing careers and entering military medicine. 07:15 – What Is a Physician Assistant?: Origins, training and the military PA role. 10:38 – PA vs Nurse Practitioner: Different educational and clinical models. 13:06 – Advising Across Eastern Europe: Building capability and interoperability. 14:19 – Inside the White House Medical Unit: Medical support for the President and First Family. 15:35 – Medical Planning for the President: Preparing for presidential travel worldwide. 17:32 – Training for High-Consequence Medicine: Trauma preparation and live-tissue training. 19:43 – Humanitarian Medicine in Tanzania: Wilderness medicine and community healthcare. 21:00 – Schistosomiasis and Sickle-Cell Care: Managing disease in resource-limited communities. 24:40 – HIV and the Problem of Follow-Up: When treatment exists but access remains difficult. 27:07 – Inside a Ukrainian Stabilisation Point: Damage-control resuscitation with limited resources. 28:45 – The Limb or the Life: The realities of prolonged tourniquet use. 30:00 – Preventing Unnecessary Limb Loss: Tourniquet reassessment and conversion. 31:56 – Sepsis in Prolonged Casualty Care: The consequences of delayed evacuation. 33:30 – Debridement Without Water: Managing contaminated battlefield wounds. 34:47 – Airways with Limited Equipment: Facial trauma and conserving resources. 36:14 – Taking PCC to the CLS and CMC: Moving prolonged-care skills further forward. 39:09 – What Should a Two-Day PCC Course Teach?: Reassessment, wounds and prolonged-care thinking. 40:45 – Stop Taking Snapshots — Start Trending: Following physiology over time. 42:13 – The “Boring” Care That Saves Lives: Nursing care, positioning, pain and pulmonary management. 43:40 – Improvised PEEP and Wound VACs: Field-expedient solutions when equipment runs out. 45:13 – Rediscovering Old Lessons: What previous wars may teach modern austere medicine. 46:27 – Medicine in the Mediterranean: Travis previews his keynote presentation. 47:45 – “Sir, Are We Gonna Be Okay?”: Trust, responsibility and caring for severely wounded soldiers. 49:49 – Advice for the Austere Clinician: Lose the ego, stay curious and learn from experience.

This week, Aebhric O'Kelly is joined by David Page, a paramedic with more than 40 years of experience spanning frontline EMS, education, accreditation and research. David directs the Prehospital Care Research Forum at UCLA and is closely involved with the International Paramedic Registry (IPR). The conversation explores the enormous variation in paramedic education and practice around the world. David discusses his work with training centres in more than 20 countries and explains why sophisticated simulation facilities are not necessarily required to deliver excellent education. Chapters 00:00 – Meet David Page: 40 years of paramedicine, research and education. 01:45 – Assessing EMS Education Around the World: Lessons from training centres in 23 countries. 04:30 – Simulation Without the Million-Dollar Lab: Creating effective training with limited resources. 05:20 – What Is the International Paramedic Registry?: Establishing international standards for paramedicine. 08:01 – Learning from the US National Registry: Why independent certification matters. 10:28 – Defining Levels of Paramedicine: Responder, basic and advanced practice. 13:03 – What Should Every Paramedic Know?: Building and validating 1,028 international competencies. 17:32 – Is IPR Becoming an International Standard?: Adoption, recognition and international mobility. 19:44 – Certification vs Licensure: An important distinction for international paramedics. 21:47 – Degree vs Certification: Does graduating from university prove clinical competency? 26:47 – Does a Degree Guarantee Competence?: Why David argues for independent verification. 28:20 – US vs UK Paramedics: Who Is Better?: Why minimum standards matter more than comparison. 29:17 – When the Same Job Title Means Different Skills: Comparing paramedic education and scope internationally. 30:35 – Does Programme Length Matter?: Why three years of education can mean very different things. 33:40 – Australia's Nurse–Paramedic Model: Different professions and different clinical environments. 36:43 – The UK Paramedic Model: Degrees, registration and the changing ambulance workforce. 39:36 – Germany, Spain and European EMS: Different routes to prehospital practice. 41:50 – Does France Have Paramedics?: Looking beyond professional labels. 44:12 – Can Nurses Take the IPR Exam?: Why hospital expertise does not automatically equal prehospital expertise. 44:52 – Paramedicine Is a Specialty: A separate environment requires a separate body of knowledge. 45:25 – Research, Education and Clinical Practice: David's three-legged stool of paramedicine. 46:56 – “Soak It Up, Buttercup”: David's advice for the next generation. 47:38 – The Privilege of Being a Paramedic: Human dignity, patients and why the work matters.

This week, Aebhric O'Kelly is joined by Jason Jarvis, a former US Army Special Forces medic, tropical medicine educator, and researcher, for a practical discussion of malaria management in remote and resource-limited environments. Jason reviews the malaria parasite life cycle and explains why understanding the liver and blood stages is important when selecting treatment. The discussion covers current management with artemether–lumefantrine (Coartem) for uncomplicated malaria and IV artesunate for severe disease. Prevention remains essential. Jason discusses bed nets, repellents and chemoprophylaxis, including Malarone, doxycycline and mefloquine, along with the advantages and adverse effects of each. The centrepiece of the episode is cabamiquine–pyronaridine. Jason discusses the recent Phase 2a research and two particularly exciting possibilities: single-dose treatment and potential activity against multiple stages of the malaria parasite. If subsequent trials support these findings, this could significantly simplify malaria treatment, particularly in remote settings where adherence to multi-dose regimens can be difficult. Jason also emphasises that cabamiquine remains investigational and requires further clinical evaluation. The conversation also explores antimalarial resistance, G6PD considerations, R21 and RTS,S malaria vaccines, and the importance of antimicrobial stewardship. Finally, Jason brings the discussion back to the remote medic: prevent mosquito bites, ensure chemoprophylaxis is taken, carry appropriate contingency treatment and have a realistic diagnostic plan. The episode closes with a discussion of microscopy, malaria rapid diagnostic tests (RDTs), and clinical diagnosis when neither is available. 00:00 – Jason Jarvis Returns: Tropical medicine and infectious-disease education. 02:00 – What Is Malaria?: Understanding the parasite. 04:30 – The Malaria Life Cycle: Mosquito, liver and blood stages. 07:00 – Treating Malaria Today: Current antimalarial therapy. 08:10 – Coartem or IV Artesunate?: Uncomplicated versus severe malaria. 09:15 – Preventing Malaria: Bed nets, repellents and mosquito avoidance. 10:00 – Chemoprophylaxis: Malarone, doxycycline and mefloquine. 11:15 – The Remote Medic's Malaria Kit: Prevention and contingency treatment. 13:30 – Mefloquine and the Nightmares: Benefits and neuropsychiatric effects. 16:15 – Introducing Cabamiquine: A potential new antimalarial. 17:30 – The Phase 2a Trial: Early clinical evidence. 20:30 – Could One Dose Treat Malaria?: The potential for single-dose treatment. 21:15 – The Resistance Problem: Protecting new antimalarials. 22:15 – Why One Dose Matters: Potential benefits in remote settings. 23:00 – Targeting Multiple Parasite Stages: Potential liver and blood-stage activity. 24:00 – Cabamiquine and Primaquine: Implications for liver-stage treatment. 25:30 – What About G6PD?: An important unanswered question. 26:15 – The Future of Malaria Treatment: Could treatment become considerably simpler? 27:10 – Malaria Vaccines: R21 and RTS,S. 28:40 – Antimalarial Resistance: Lessons from Southeast Asia. 30:00 – Advice for the Remote Medic: Practical preparation for malaria. 32:30 – Diagnosing Malaria in the Field: Microscopy and diagnostic planning. 34:15 – Choosing a Malaria RDT: HRP2 and pLDH testing. 35:30 – No RDT, No Microscope: Clinical diagnosis and presumptive treatment. 37:00 – Final Thoughts: Key lessons for austere clinicians.

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. Chapters 00:00 – Introduction: Christoffer Mäkitalo Twenty years of prehospital medicine, military nursing and civil defence work in northern Sweden. 01:41 – When Prolonged Care Is Just Normal Care Why one-hour-plus evacuation timelines are an everyday reality for ambulance clinicians in northern Sweden. 03:44 – Medical Training in Ukraine Christoffer's repeated deployments and the evolution from basic TCCC towards instructor development, blood resuscitation and ultrasound. 06:20 – Taking Prolonged Casualty Care to the CLS Piloting 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 Battlefield Wound care, hygiene, keeping casualties dry and warm, elimination and other fundamental care when evacuation is delayed. 11:34 – The Battlefield Has Changed Why 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 Agency Humanitarian operations, international deployments and supporting UN and EU missions around the world. 17:12 – Working as a Swedish Combat Nurse Combining civilian clinical practice with military medicine 19:49 – Remote Ambulance Medicine in Northern Sweden Working with limited resources, long distances and the need to become an effective clinical problem-solver. 23:28 – When HEMS Is Not Available Deciding when to request helicopter support and the operational challenges of weather, icing and enormous geographical coverage. 26:23 – Cross-Border Rescue and Evacuation Cooperation with Norwegian and Finnish services and the capabilities available across Scandinavia. 27:28 – The Swedish Ambulance Nurse Education, 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 Evacuation Moving patients over long distances for specialist and critical care unavailable locally. 35:14 – Advice for the New Austere Clinician Curiosity, humility, lifelong learning and finding the area of medicine that genuinely matters to you.

Aebhric O'Kelly is joined by Dr Csaba Dioszeghy, CoROM co-founder and CEO, critical care and emergency medicine consultant, cardiologist, and experienced prehospital clinician. The conversation explores what makes education for remote and austere clinicians fundamentally different from conventional medical education. CoROM students work across the world in military, humanitarian, offshore and other resource-limited environments. Csaba discusses why education needs to adapt to these clinicians rather than expecting their professional lives to conform to a traditional university model. A major theme is listening to students. Aebhric and Csaba discuss how student feedback has directly influenced CoROM's curriculum, facilities, administration and teaching methods — including significant changes being introduced for the new academic year. They also discuss the redevelopment of the MSc in Austere Critical Care, including more interactive online learning, greater flexibility for students who cannot travel to Malta, and expanded opportunities for practical education. The discussion considers an important question for modern medical education: how much of postgraduate austere medicine can genuinely be taught online, and what still requires hands-on experience? Chapters 00:00 – Welcome to Season 5 A new academic year, a new podcast season and the changing face of CoROM. 00:38 – CoROM's Next Chapter Csaba's role as CEO, consolidating a decade of growth and the College's ambitions for the future. 03:02 – What Makes CoROM Different? Building flexible education for clinicians working across military, humanitarian, offshore and resource-limited environments. 06:52 – Listening to Our Students How student feedback directly influences curriculum, facilities and the way CoROM teaches. 09:23 – Changing the Practical Curriculum Revamping classroom education, investing in facilities and placing greater emphasis on hands-on learning. 11:34 – Rebuilding the MSc in Austere Critical Care New modules, interactive education and moving beyond traditional recorded online lectures. 13:07 – Can You Teach Austere Critical Care Online? Accessibility, international students and why the redesigned MSc can now be completed without compulsory travel to Malta. 18:01 – Improving Support for Online Students Human faculty support, central administration and improving communication with students. 19:54 – Building a Better Student Information System Modernising the administrative infrastructure behind a growing international College. 21:02 – Building the CoROM Community The future of CoROM's membership structure and strengthening the wider professional community. 23:05 – The CoROM Digital Library Building offline access to field guides, publications and educational resources. 25:41 – A New Digital and Physical CoROM New content, facilities, Moodle, equipment and the systems being developed for the new academic year. 28:05 – Quality Assurance and the Future of CoROM Institutional review, reaccreditation and the longer-term direction of the College. 29:33 – More Hands-On, Less PowerPoint Updating the BSc and MSc programmes and increasing practical learning when students come to Malta. 32:17 – International Partnerships Growing educational, clinical and research relationships around the world. 34:02 – Advice for the New Austere Medic What should a doctor, nurse or medic entering austere medicine concentrate on? 35:00 – When Guidelines Don't Fit the Environment Why guidelines developed in well-resourced healthcare systems may not always translate directly into resource-limited care. 36:02 – Your Brain Is Still a Resource Understanding physiology, thinking beyond protocols, innovation and Csaba's final advice: be brave and don't give up.

This week, Aebhric O'Kelly is joined by Professor Mark Hannaford, founder and CEO of World Extreme Medicine, to discuss the evolution of expedition medicine, humanitarian response, and the growing importance of prolonged casualty care in modern conflict. From kayaking in Patagonia and Antarctica to developing one of the world's leading extreme medicine organisations, Professor Hannaford shares the experiences that shaped his career and explains how World Extreme Medicine has become a global leader in expedition medicine education, research and humanitarian training. About the Speaker Professor Mark Hannaford is the Founder and CEO of World Extreme Medicine (WEM), an organisation dedicated to advancing healthcare in remote, austere and expeditionary environments. Topics Covered Professor Hannaford's journey into expedition and extreme medicineThe origins and philosophy of World Extreme MedicineWhy expedition medicine is about far more than trauma careThe importance of primary care in remote environmentsDeveloping multidisciplinary expedition medical teamsBreaking down barriers between military, humanitarian and civilian medicineLessons learned from humanitarian work in UkraineTraining civilians in Stop the Bleed and emergency trauma careThe growing importance of Prolonged Casualty Care in modern warfareHow drone warfare is changing casualty evacuationCreating the MSc in Extreme Medicine at the University of ExeterWhy research is essential for advancing austere medicineAdvice for clinicians interested in expedition medicineThe importance of mastering the basics before deployingBuilding experience through events, rescue organisations and outdoor medicineThe future of extreme medicine and global medical education Chapters 00:00 – Introduction Introducing Professor Mark Hannaford Correct pronunciation and welcome 00:36 – Mark's background From geographer to expedition leader Living in Abu Dhabi A lifetime in expedition and remote medicine 02:02 – Supporting Ukraine The origins of the World Extreme Medicine Fund Choosing a focused humanitarian mission Current work in Ukraine 04:43 – Adventures in British Columbia Kayaking with orcas Patagonia expeditions Antarctica and the Arctic Wildlife and expedition life 09:56 – How World Extreme Medicine began Early expedition medicine Standardising expedition medical support Paying expedition medics Building multidisciplinary teams 15:04 – Breaking down medical silos Why WEM became World Extreme Medicine Bringing together military, humanitarian, wilderness and expedition medicine The evolution of the WEM Conference 17:47 – Medicine beyond medicine Expedition skills Bushcraft Vehicle safety Risk management 19:17 – Primary care versus trauma The reality of expedition medicine Why prevention matters 20:29 – The WEM Fund in Ukraine Medical supply convoys TCCC and Stop the Bleed Training civilians Building local capability 27:44 – Prolonged Casualty Care Changing battlefield realities Drone warfare Extended evacuation times Adapting PCC education to frontline needs 30:03 – Sharing Ukraine's lessons Teaching civilians NATO exercises Disseminating battlefield medical lessons 32:27 – Creating the MSc in Extreme Medicine Partnership with the University of Exeter Professionalising expedition medicine Research priorities Translating austere medicine into mainstream healthcare 37:59 – Advice for new expedition medics Master the basics Know your limits Gain domestic experience Find mentors Say yes to opportunities 40:36 – Final advice Prepare for your environment Listen more than you speak 41:22 – Closing remarks Reflections on Professor Hannaford's contribution Final thoughts and thanks

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. Chapters 00:00 – Introduction: Why OTC medicines matter in austere medicine 02:22 – Traveller's diarrhoea AssessmentOral rehydrationLoperamide: when to use it (and when not to)06:54 – Upper respiratory infections Symptom managementSalt-water garglesSaline spraysWhen antibiotics are unnecessary13:34 – Musculoskeletal injuries Pain packsDiclofenacPatient-guided pain managementRICE and the ice debate20:45 – Allergic rashes and contact dermatitis HydrocortisoneAntihistaminesOatmealRecognising anaphylaxis23:02 – Insect bites and stings Local treatmentCold therapyWhen to escalate care25:21 – Dehydration Oral rehydrationIV versus oral fluidsHydration strategies in the field29:59 – Heat illness Cooling methodsField managementPreventing heat injury32:15 – Acid reflux in austere environments AntacidsGingerPractical management tips32:15 – Minor wound care IrrigationSoap versus antisepticsDakin's solutionAlcohol and iodinePractical wound cleaning36:45 – Building the ideal austere OTC medical kit Essential medicationsDressingsTapeWater purificationSplintsEpiPensMulti-use equipment41:20 – Final discussion, audience questions and wrap-up The 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 Messages Good 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 Speakers Aebhric 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 Mentioned World Health Organization Oral Rehydration Solution (ORS) Wilderness Medical Society clinical practice guidelines Joint Trauma System Clinical Practice Guidelines (JTS CPGs) Bristol Stool Chart Ottawa Ankle Rules Listen, Learn, Deploy Whether 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.

This week, Aebhric is joined by Luca Alfatti, an advanced paramedic and co-founder of the World Extreme Medicine Fund, who shares insights from his global medical missions, including recent work in Ukraine and NATO exercises. Discover how adaptable training and international collaboration are transforming emergency medicine in conflict zones. Chapters 00:00 Introduction to Luca Alfadi and his background 02:10 Luca's journey from expedition leader to advanced paramedic 05:02 Founding of the World Extreme Medicine Fund 06:57 Medical aid efforts in Ukraine during the war 11:59 Training Ukrainian medics in prolonged casualty care 15:59 Challenges of medical resource limitations in conflict zones 20:09 Adapting training to frontline needs and experience levels 25:06 Participation in NATO Vigorous Warrior exercise 27:59 Lessons learned from NATO exercise on prolonged casualty care 31:59 Upcoming publication in the Journal of Special Operations Medicine 35:03 Psychological and societal impacts of war on healthcare workers 38:01 The importance of international collaboration and relationships 39:06 Advice for new medics entering austere medicine 39:50 Closing remarks and future outlook Keywords extreme medicine, Ukraine, prolonged casualty care, NATO exercises, medical training, humanitarian aid, expedition medicine, medical innovation, war zones, emergency response Key Topics International medical aid in Ukraine Prolonged casualty care training NATO Vigorous Warrior exercise insights Innovations in casualty extraction and treatment Adapting medical practices to resource-limited settings The importance of listening to frontline medics Psychological impacts of war on healthcare workers Building international medical collaborations

This week, Aebhric O'Kelly speaks with David Stanton, a search and rescue paramedic, former Medic One paramedic, wilderness medicine educator, researcher at the University of Nottingham, and humanitarian medical instructor. David discusses why exceptional basic life support remains the foundation of all advanced medical care, explores innovations from Seattle's renowned Medic One system, shares lessons from Ukraine, and explains his research into prolonged casualty care and medical intelligence. Chapters 00:00 – Introduction and David Stanton's background 01:00 – The Seattle Medic One system explained 03:00 – Why Seattle achieves exceptional cardiac arrest survival 06:30 – Innovation, research and improving patient outcomes 08:20 – Head-up CPR and evolving resuscitation science 10:00 – Good ALS begins with great BLS 13:00 – Building confident and capable EMTs 17:00 – Should every EMT become an Advanced EMT? 20:30 – Teaching maxillofacial trauma management in Ukraine 23:00 – Learning from Ukrainian combat medicine 27:30 – Teaching wilderness medicine at Nottingham 29:20 – Medical intelligence as an intelligence discipline 32:00 – Rethinking prolonged casualty care 35:00 – Constraint as the foundation of prolonged casualty care 38:30 – NATO's Vigorous Warrior exercise 40:20 – Final advice for new austere medical providers About the Guest David Stanton is a search and rescue paramedic with nearly two decades of pre-hospital experience. His career includes service within Washington State's Medic One system, international rescue operations, humanitarian medical education, and research at the University of Nottingham. His current work focuses on prolonged casualty care, medical intelligence, wilderness medicine, and improving healthcare delivery in austere and conflict environments. Keywords Seattle Medic One, David Stanton, paramedic, EMT, Advanced EMT, CPR, cardiac arrest, BLS, ALS, wilderness medicine, austere medicine, prolonged casualty care, combat medicine, Ukraine, medical intelligence, NATO, Vigorous Warrior, TCCC, JTS, CoROM Podcast

This week, Aebhric is joined by Fred, who has spent almost four and a half years working in military and military-adjacent medicine in Ukraine, primarily on the forward line of troops (FLOT), with additional experience at casualty collection points and stabilisation points. In this episode, he and Aebhric trace how combat casualty care has changed since 2022: evacuation timelines have stretched from minutes to weeks, wounding patterns have shifted as troop formations disperse to avoid drone strikes, and medics on the ground are being asked to deliver prolonged field care (PFC) far beyond their training. The conversation covers current combat wound pack medications, the phase-out of nalbuphine, tramadol's hepatotoxicity risk in dehydrated patients, the training gap between CLS/CMC-qualified providers, and the disease and non-battle injury (DNBI) burden from leptospirosis to Lyme disease to anthrax that frontline medics are managing largely on their own. Chapters 00:00 – Introduction and guest welcome 01:00 – Four years of medical experience on the Ukrainian front 02:00 – How drone warfare has changed casualty patterns 03:10 – Evolution of TCCC and prolonged evacuation 04:20 – Changes to battlefield medications and analgesia 06:00 – Ketamine, morphine and tramadol in prolonged casualty care 08:00 – The challenge of prolonged pain management 09:15 – Nerve blocks and expanding combat medic skills 10:15 – Closing the knowledge gap for frontline medics 12:00 – Self-directed learning and educational resources 13:15 – Current medical training available in Ukraine 15:00 – Could prolonged casualty care become a formal certification? 16:00 – A day in the life of a frontline combat medic 18:15 – Drone casualty evacuation: promise and limitations 20:00 – What knowledge do combat medics really need? 22:00 – Disease, dehydration and prolonged field medicine 23:20 – Final advice for new austere medical providers Evolving battlefield medicine. Evacuation that once happened within minutes from positions near the front now can take weeks, driven by pervasive drone surveillance and strike capability. Mass casualty incidents near the front line have become less common as units disperse, changing the injury and casualty flow medics have to plan for. Training and knowledge gaps. There's a wide spread in provider background — from Ukrainian feldshers (registered-nurse equivalent) to personnel who completed a seven-day CMC course — all filling the same frontline medic role. Nerve blocks beyond digital blocks aren't commonly taught. Fred argues CMC training was never meant to stand alone; it assumes a prior EMT-level foundation that many providers don't have. Training availability is inconsistent and largely filled by NGOs of varying quality, with NAMT/CLS/CMC certification currently the closest thing to a standard. Evacuation reality on the ground. Getting to a casualty may take hours to days depending on drone "weather windows." Waits of 30–60 days for evacuation are not unheard of. As a result, stabilisation points are increasingly seeing patients who would survive regardless of intervention, rather than the critical mid-triage-category patients medics are most needed for. Ground evacuation drones (UGVs) are seeing real use but only for stable patients, since medics can't manage an airway or maintain a sedated patient during transit; aerial casualty evacuation is currently considered infeasible due to drone threats. Disease and non-battle injury (DNBI). Fred and Aebhric discuss the need for a Ukraine-specific DNBI framework and better environmental/threat updates reaching medics in the field. Closing advice. Fred's advice for new medics, nurses, and physicians entering austere medicine: keep learning and keep developing — people are counting on you to do your job well.