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

This week, we have another Medicine in the Mediterranean Conference speaker from January 2025. Our Vice Dean Eric Bauer talks about the PHACTORS mnemonic for managing patients in the post-intubation phase, emphasising the importance of understanding and addressing post-intubation hypotension, the role of positive pressure ventilation, and the need for ongoing resuscitation efforts. The discussion highlights various factors that can impact patient outcomes, including the transfer phase and the importance of proactive care in emergency medical settings.TakeawaysPost-intubation hypotension remains a significant challenge.The 'Platinum 10' refers to the critical 10 minutes post-intubation.Positive pressure ventilation can negatively impact haemodynamics.Hypoxia must be evaluated continuously after intubation.The transfer phase is often overlooked but crucial for patient care.Ongoing resuscitation is essential and should not stop after intubation.Good BLS and ALS care can significantly improve outcomes.Understanding the patient's history is vital for effective management.Proactive airway management leads to better patient outcomes.Continuous education on ventilation techniques is necessary.Chapters00:00 Introduction to Post-Intubation Management01:14 Understanding Post-Intubation Hypotension03:49 Factors Affecting Post-Intubation Outcomes10:10 The Role of Positive Pressure Ventilation14:19 Evaluating Hypoxia and Its Causes19:15 The Importance of Transfer Phase23:09 Ongoing Resuscitation and Pharmacology28:57 Final Thoughts on Post-Intubation Care

This week, Aebhric O'Kelly talks with Dr Matias Nocetto, the Vice President of Divers Alert Network (DAN), who shares his journey from Argentina to becoming a key figure in diving medicine. He discusses DAN's unique operations, the importance of understanding diving-related medical issues, and the challenges faced in diagnosing and treating divers. Dr. Nocetto emphasises the significance of training in diving medicine and offers advice for new medical professionals looking to enter this field.TakeawaysDr. Nochetto's journey reflects a lifelong passion for diving and medicine.DAN serves as a global resource for divers experiencing medical issues.The hotline operates 24/7, providing critical support to divers worldwide.Understanding the symptoms and history is crucial for diagnosing diving-related conditions.Decompression sickness is often misunderstood; cardiac events are a significant risk.In-water recompression is a controversial practice with many risks.Training opportunities in diving medicine are available for various medical professionals.DAN offers CME courses for those interested in diving medicine.Collaboration and support from the diving community are vital for DAN's mission.Following one's passion can lead to unexpected and fulfilling career paths.Chapters00:00 Introduction to Dr. Matias Nochetto and DAN02:52 The Journey into Diving and Medicine10:55 Day-to-Day Operations at DAN19:47 Understanding Diving Medicine and Decompression Sickness30:08 In-Water Recompression: Risks and Considerations36:15 Training Opportunities in Diving Medicine41:59 Advice for New Medical Professionals in Diving Medicine

This week, Aebhric O'Kelly speaks with Jason Jarvis, a former Special Forces medic and current PhD student, about his experiences in military medicine, the evolution of prolonged field care, and the development of the 'SHEEP VOMIT' mnemonic for patient care in austere environments. They discuss the importance of nursing care, the practical applications of medical knowledge in the field, and the challenges medical practitioners face in remote settings. This conversation delves into critical aspects of patient care, particularly in prolonged field care settings. It emphasises the importance of managing pressure points, understanding vital signs, monitoring core temperature, maintaining oral hygiene, preventing DVT, and ensuring proper input and output monitoring. The discussion also highlights the significance of turning, coughing, and deep breathing for patient recovery, culminating in the legacy of the 'sheep vomit' concept in medical training.TakeawaysJason Jarvis has a master's in infectious disease and is pursuing a PhD.Military experiences shaped his interest in tropical medicine.Prolonged field care is a systematic approach to patient care in remote settings.The 'SHEEP VOMIT' mnemonic was developed to aid in prolonged field care.Skin protection is crucial in austere environments.Hypothermia prevention is a key focus in field care.Patient mobility and exercises are essential for recovery.Checklists help ensure comprehensive patient care.The evolution of medical mnemonics reflects advancements in field medicine. Pressure sores develop in specific areas when supine.Vital signs must be documented and trended over time.Core temperature is crucial for assessing trauma patients.Oral hygiene prevents infections that can lead to pneumonia.DVT prevention is essential for immobilised patients.Urine output is a key indicator of hydration and health.Turning and coughing help maintain lung function.The 'SHEEP VOMIT' concept aids in prolonged field care training.Training should prepare providers for practical challenges.Community impact is a goal of medical training.Chapters00:00 Introduction to Jason Jarvis 00:46 Jason Jarvis: Background and Current Work02:37 Military Experiences and Deployments05:58 Transitioning to Civilian Life and DMI09:52 Prolonged Field Care: Concepts and Evolution13:45 Developing the Sheep Vomit Mnemonic18:35 Understanding the Sheep Vomit Mnemonic21:58 Practical Applications of Prolonged Field Care26:12 Exercises and Patient Mobility29:35 Managing Pressure Points in Patient Care30:05 Understanding Vital Signs and Their Importance31:10 The Role of Core Temperature in Patient Assessment32:40 Oral Hygiene and Its Clinical Significance36:02 Preventing Deep Vein Thrombosis (DVT) in Immobilised Patients40:44 Monitoring Input and Output: A Vital Sign49:04 The Importance of Turning, Coughing, and Deep Breathing55:00 The Legacy of Sheep Vomit in Medical Training

This week, Aebhric O'Kelly talks with Professor Enrico Brunetti about his extensive experience with ultrasound in infectious diseases and tropical medicine. He shares insights into the evolution of ultrasound technology, its applications in clinical practice, and the importance of education in this field. The discussion also covers the short course he developed at the University of Pavia, the challenges faced in tropical medicine, and advice for new medics interested in ultrasound.TakeawaysUltrasound has been a clinical tool since the 1980s.There are continuous advancements in ultrasound applications.Training is crucial for effective ultrasound use.The short course aims to broaden understanding of ultrasound in tropical medicine.Postgraduate certification is available for online courses.Ultrasound can diagnose and treat various tropical diseases.Networking and collaboration are key in medical education.Challenges in tropical medicine require innovative solutions.Patience is essential for mastering ultrasound skills.The global movement for ultrasound in emergency medicine is growing.Chapters00:00 Introduction to Professor Enrico Brunetti05:02 The Evolution of Ultrasound in Clinical Practice10:04 Ultrasound Applications in Infectious Diseases15:03 The Short Course in Ultrasound and Tropical Medicine from Pavia19:48 Postgraduate Certification and Online Learning24:52 Challenges and Opportunities in Tropical Medicine29:49 Advice for New Medics in Ultrasound Practice

This week, we have another MiM25 presentation from Dr John Quinn discussing Damage Control Resuscitation in large-scale combat operations, particularly in Ukraine. He shares insights from his extensive experience in emergency medicine and highlights the unique challenges faced in combat medicine, including medical logistics, terminology, and telemedicine. Dr. Quinn emphasises the importance of training, clinical governance, and the need for effective blood supply management in austere environments. The conversation also touches on the evolving practices in casualty care and the impact of modern warfare on medical operations.TakeawaysUkraine has surpassed NATO in counterinsurgency experience.Effective medical planning is crucial for combat operations.Telemedicine enhances clinical decision-making in remote areas.Logistical challenges significantly impact casualty evacuation.Understanding the terminology is essential for interoperability.Innovations like RBOA are being utilised in combat medicine.Training and capacity building are vital for partner forces.Blood supply issues are critical in combat settings.Tourniquet management is a significant concern in Ukraine.Plasma is being used due to a lack of blood supply.Chapters00:00 Introduction to the CoROM Podcast00:45 Dr. John Quinn's Background and Experience02:13 Key Assumptions in Damage Control Resuscitation03:42 Medical Planning in Large-Scale Combat Operations05:11 Challenges in Medical Logistics and Command07:35 Understanding Terminology and Echelons of Care09:58 Tactical Combat Casualty Care and Innovations11:52 Telemedicine's Role in Combat Medicine13:47 Challenges in Casualty Evacuation15:40 Logistical Challenges in Blood Supply17:34 Wounding Patterns and Weapon Systems19:50 Medical Evacuation in Challenging Environments22:35 Training and Capacity Building in Ukraine24:59 Clinical Governance and Standards in Ukraine27:39 Transfusion Practices and Challenges30:54 Addressing Tourniquet Issues and Training33:39 Plasma Use and Blood Supply Challenges36:51 Conclusion and Future Directions

This week, Aebhric OKelly talks with Leandra Lynn, a combat medic and Divers Alert Network (DAN) professional, who shares her experiences and insights into the world of diving medicine. She discusses her journey from being a linguist to a combat medic, the critical role of DAN in dive safety, and the challenges faced in handling emergency calls related to diving injuries. Leandra emphasises the importance of proper medical guidance for divers, the varying standards of diving medicine across the globe, and the benefits of DAN membership for divers. She also advises new medics entering the field of diving medicine, highlighting the significance of utilising available resources and seeking expert guidance.TakeawaysLeandra Lynn is a combat medic and works with DAN.DAN provides a 24-hour emergency hotline for divers.Diving procedures vary by region due to different medical standards.Barotrauma is the most common diving injury reported to DAN.DAN membership offers benefits like medical evacuation and insurance.Divers should consult dive medicine specialists for complex medical histories.Learning to dive in challenging conditions prepares divers for emergencies.DAN assists with global non-emergency dive safety questions.Effective communication is crucial in handling diving emergencies.New medics should leverage resources and ask questions for better outcomes.Chapters00:00 Introduction to Leandra Lynn and Her Work03:01 Diving into the Role of a Combat Medic05:51 Understanding Divers Alert Network (DAN)09:02 Challenges in Diving Medicine Calls12:02 Diving Procedures and Medical Standards Worldwide14:57 The Importance of DAN Membership17:50 Common Diving Emergencies and Injuries20:46 Resources for Diving Medicine24:01 Advice for New Medics in Diving Medicine

This week, we have another MiM25 presentation. Dr Trevor Abela discusses the unique role of nurses in Malta's emergency services, the historical context of nursing in the region, and the importance of holistic care and building trust in nursing practice. Dr Abela emphasises the need for nurses to focus on the patient as a person rather than just a set of medical needs and highlights the significance of context in providing effective care.TakeawaysMalta has a unique nurse-led ambulance service.Historical context is crucial for understanding current nursing practices.Nurses should focus on the person, not just on medical tasks.Building trust with patients is essential for effective care.Holistic care includes addressing social and psychological factors.Emergency care must go beyond basic medical priorities.Nursing education should emphasise patient-centred care.The relationship between nurse and patient impacts treatment outcomes.Nurses play a vital role in community health beyond hospitals.Clinical outcomes do not solely define success in nursing.Chapters00:00 Introduction to the Quorum Podcast00:44 Nursing in Malta: A Unique Perspective03:11 Historical Context of Nursing in Malta06:34 The Role of Nurses in Emergency Services11:37 Understanding Nursing: Capital N vs. Small n18:02 The Importance of Context in Nursing Care25:42 Holistic Care in Pre-Hospital Settings34:19 Building Trust and Relationships in Nursing40:48 Conclusions and Reflections on Nursing Practice

In this episode, Aebhric OKelly interviews Dr Ella Corrick and Dr Tom Mallinson to discuss their experiences at the SOMA Conference, focusing on the Wilderness Paramedic Workshop. They explore the common challenges faced in austere medicine, the significance of prolonged field care, and the preparation for the Wilderness Paramedic Certification exam. The conversation also delves into creating educational resources to enhance decision-making skills in wilderness medicine. In this conversation, Dr Tom and Dr Ella discuss their experiences and insights into wilderness medicine, focusing on exam preparation for the Wilderness Paramedic Certification (WP-C) and creating a revision guide tailored for practitioners in austere settings. They highlight the challenges of multiple-choice exams, the importance of distilling complex medical knowledge into practical applications, and the value of interactive learning experiences at conferences like SOMA. The discussion also emphasises the significance of networking, learning from peers, and embracing challenges in medical practice.TakeawaysSOMA Conference fosters a welcoming environment for civilian practitioners.Common challenges in austere medicine include distance to hospitals and limited resources.Wilderness Paramedic Certification covers a broad curriculum that includes environmental medicine.Exam preparation requires understanding both wilderness concepts and core medical principles.Prolonged field care is essential for managing critically ill patients in remote settings.Teaching decision-making in wilderness medicine is challenging but crucial.Educational resources aim to bridge knowledge gaps for WPC candidates.Collaboration between military and civilian practitioners enhances learning.Experience in austere settings improves exam performance and patient care.The integration of nursing and paramedic skills is beneficial in prolonged field care. The challenge was to distil down the knowledge needed for the exam.Multiple choice exams can be misleading in complex scenarios.The WPC revision guide focuses on core concepts for wilderness medicine.Each chapter of the guide could be a whole textbook.The workshop aims to address common blind spots in practice.Exam techniques are crucial for success in certification.Networking at conferences enhances learning opportunities.Embracing challenges leads to better patient care.Learning from others' mistakes accelerates professional growth.Take opportunities that excite you for long-term benefits.Chapters00:00 Introduction to SOMA Conference and Wilderness Paramedic Workshop02:52 Common Ground in Austere Medicine06:03 Overview of Wilderness Paramedic Certification09:12 Exam Insights and Preparation Strategies11:57 Prolonged Field Care and Patient Management14:48 Creating Educational Resources for WP-C18:10 Challenges in Teaching Decision-Making in Wilderness Medicine24:57 Distilling Knowledge for Exam Preparation25:36 Challenges of Multiple-Choice Exams

This week, we have another Medicine in the Mediterranean conference presentation. We will hear from Tactical Medicine North, a volunteer medical unit operating in Ukraine. The discussion covers their formation, mission, and challenges in training combat medics on the frontlines. Key topics include injury patterns, trauma management, blood logistics, and improved training in prolonged casualty care. The presenters emphasise the importance of adapting medical practices to the unique challenges of combat situations in Ukraine.TakeawaysTactical Medicine North was formed out of necessity due to the war in Ukraine.Training combat medics is crucial for effective frontline care.Injury patterns in Ukraine reveal a high incidence of non-combat injuries.TCCC is essential but needs adaptation to local conditions.Blood management logistics are a significant challenge in combat zones.Tourniquet use and wound management require more comprehensive training.Prolonged casualty care is often neglected in training programs.Collaboration with international organisations enhances training effectiveness.Understanding the unique challenges of Russian casualties is important for medical personnel.Future training must focus on nursing skills and prolonged care techniques.Chapters00:00 Introduction to Tactical Medicine in Ukraine02:49 The Formation and Mission of Tactical Medicine North05:12 Training and Challenges on the Frontline09:51 Understanding Injury Patterns and Casualty Statistics13:00 Trauma Challenges: TBI and Pre-Hospital Care20:28 Blood Management and Logistics in Combat23:43 Tourniquet Use and Wound Management26:58 Challenges with Russian Casualties and Evacuation30:23 Prolonged Casualty Care and Training Needs34:41 Conclusion and Future Directions

This week, Aebhric OKelly talks with Cory Igo, who is an alumnus of the CoROM Remote Paramedic programme. Cory shares his journey from being a United States Marine to becoming a remote paramedic, highlighting his experiences in veteran rehabilitation through Brazilian Jiu Jitsu, the challenges of working in remote medical settings, and the lessons learned from his deployments in Ukraine. He discusses the importance of adaptability in medicine, especially in challenging environments, and offers insights into the future of rehabilitation for injured veterans.TakeawaysCory Igo is a former Marine turned remote paramedic.Brazilian Jiu Jitsu aids in the rehabilitation of veterans.The transition from military to medical work can be challenging.Choosing the right paramedic program is crucial for practical skills.Cory's first paid job involved a reality show in Tanzania.Altitude sickness can affect individuals differently during climbs.Ukrainians are innovating in medical practices amidst conflict.3D printing is becoming significant in medical applications.Learning to adapt is essential for new medical professionals.Cory emphasises the importance of local knowledge in medicine.Chapters00:00 Introduction to Corey Igo03:01 The Role of Brazilian Jiu Jitsu in Veteran Rehabilitation06:04 Transitioning from Marine to Paramedic08:57 Choosing the Right Paramedic Program12:08 Experiences in Remote Paramedicine15:07 First Paid Job as a Paramedic17:57 Altitude Medicine and Climbing Kilimanjaro21:08 Working in Ukraine and Lessons Learned24:06 Future Aspirations in Rehabilitation27:09 Advice for New Medical Professionals

This week, Dr Jon Christensen discusses the critical role of mindset in medical practice, particularly in remote and resource-limited environments. He emphasises the importance of psychological first aid, decision-making under stress, and building resilience through self-care practices. Drawing from personal experiences and historical examples, Dr Christensen illustrates how mindset can shape outcomes in personal and professional contexts, ultimately leading to better patient care and personal growth.TakeawaysMindset significantly influences personal and professional outcomes.Understanding psychological first aid is crucial for first responders.Resilience can be built through self-care and awareness practices.Decision-making is often influenced by biases and heuristics.Isolation can lead to increased mental health issues.Nutrition and exercise play vital roles in mental well-being.Meditation and mindfulness can help manage stress and improve focus.Building connections and mentorship is essential for personal growth.Understanding one's legacy can motivate personal change.Success is defined by personal growth and the impact on others.Chapters00:00 Introduction to Mindset in Medicine03:08 The Importance of Mindset18:52 Risk and Decision-Making in Medicine27:03 Psychological First Aid and Its Importance33:10 Building Resilience and Self-Care49:20 Personal Journey and Lessons Learned

This week, Aebhric O'Kelly talks with Francois Duquette, a Quebec nurse who shares his unique experiences working in remote northern communities. He discusses the challenges of providing emergency care without immediate physician support, adapting nursing practices, and using technology like point-of-care ultrasound in austere environments. Francois recounts intense experiences, including multiplemedevacs and critical patient care situations, emphasising the need for continuous learning and training in unpredictable scenarios. He also offers valuable advice for new medics and nurses entering the field. TakeawaysFrancois has a diverse academic backgroundin political science and health law.He has worked in emergency care and remotenursing since 2017.Nurses in northern Quebec often workwithout immediate physician support.Adaptation of nursing practice is crucialin remote areas.Francois emphasizes the importance oftriage in emergency situations.Technology like POCUS is limited in remotehealthcare settings.Francois shares intense experiences fromhis nursing career.Continuous learning is essential forhealthcare professionals in austere environments.Language skills enhance communication andpatient respect in healthcare.Francois encourages new medics to embracechallenges and keep learning.Chapters00:00 Introduction to Francois Duquette01:53 Emergency Nursing in Remote Areas05:50 Challenges of Medical Practice Without Immediate Support09:50 Utilising Technology in Remote Healthcare13:55 Intense Experiences in Northern Nursing22:07 The Reality of Triage in Austere Environments28:03 Lessons Learned from High-Pressure Situations33:53 The Importance of Continuous Learning in Nursing39:59 Advice for New Medics and Nurses

This week, Aebhric O'Kelly talks with David Steade, who shares his journey through emergency medical services and military service. He details his experiences in Germany, his transition to the 160th Special Operations, and the challenges of flight medic training. He emphasizes the importance of continuous learning in the medical field and offers valuable insights for new medics and nurses entering austere medicine.TakeawaysDavid's journey into EMS began in the 1990s.He experienced a culture shock when moving to Germany.His time in Germany included both medical training and cultural exploration.David transitioned to the 160th Special Operations for advanced training.Flight medic training was highly competitive and intense.The 160th is known for its role in special operations and support.David shared memorable medical cases from his time in the 160th.He emphasized the importance of learning from mistakes in medicine.David recommended practical advice for new medics entering austere medicine.Continuous learning is essential for all medical professionals.Chapters00:00nIntroduction to David Steade02:50 David's Journey into EMS and Military Service06:45 Experiences in Germany as a Medic09:23 Transitioning to the 160th Special Operations12:00 Flight Medic Training and Challenges18:14 Understanding the 160th Special Operations24:10 Memorable Medical Cases in the 160th28:00 Advice for New Medics and Nurses

This week, Jason Jarvis joins Aebhric O'Kelly on a deep dive into malaria, covering the lifecycle, symptoms, diagnostic tools, treatment options, and the latest vaccine developments. The discussion emphasises the importance of understanding malaria's complexities, the challenges in diagnosis and treatment, and the promising advancements in vaccine research to eradicate this deadly disease.TakeawaysParasitic protozoa transmitted by Anopheles mosquitoes cause malaria.The lifecycle of malaria involves complex stages in both mosquitoes and humans.Symptoms of malaria can vary significantly based on previous exposure to the disease.Severe malaria can lead to critical conditions like altered consciousness and hypoglycaemia.Rapid diagnostic tests (RDTs) are essential but not foolproof in detecting malaria.The R21 malaria vaccine shows promising efficacy and significantly advances malaria prevention.Public health efforts primarily focus on protecting vulnerable populations, especially children.Understanding the fever patterns can aid in diagnosing malaria and other diseases.Vaccination for adults is being researched, but current recommendations prioritise children.Staying informed through reputable sources like WHO and CDC is crucial for those travelling to malaria-endemic areas.Chapters00:00 Introduction to Malaria and Its Lifecycle14:58 Understanding Malaria Symptoms and Severity30:07 Diagnostic Tools and Treatment Options34:09 Vaccines: Current Developments and Future Prospects44:57 Resources for Further Learning

This week, Aebhric O'Kelly talks with Dr Daniel Grace, who shares his journey into expedition medicine, discussing his unconventional path from general practice to working in the outdoors. He emphasises the importance of academic frameworks in expedition medicine, the human factors influencing pre-hospital care, and his experiences with mountain rescue and tropical medicine initiatives. Dr Grace also reflects on memorable expeditions and offers advice for aspiring expedition medics.TakeawaysDr Grace has been a GP since 2017, seeking unconventional medical paths.His interest in expedition medicine was sparked by a wilderness medicine course.There is a lack of a recognised framework for expedition medicine in the UK.Human factors play a crucial role in the success of pre-hospital care.Mountain rescue provides an opportunity to develop technical skills in a local setting.Training for mountain rescue includes various medical competencies and practical exams.Tropical medicine knowledge is beneficial for expedition work and telemedicine roles.The Virtual Doctors charity connects UK doctors with clinicians in Zambia for telemedical advice.Dr Grace's favourite expedition was working in the Yukon during extreme winter conditions.He advises new medics to always say yes to opportunities, as they can lead to unexpected paths.Chapters00:00 Introduction to Expedition Medicine and Dr Daniel Grace02:13 The Journey into Expedition Medicine05:50 The Need for Academic Framework in Expedition Medicine10:02 Human Factors in Pre-Hospital Care12:10 Experiences in Mountain Rescue18:02 Training and Development in Mountain Rescue21:00 Tropical Medicine and Telemedicine Initiatives27:04 Memorable Expeditions and Future Aspirations30:02 Advice for Aspiring Expedition Medics

This week, Aebhric O'Kelly talks with the new CoROM faculty, Dr Sean Bilodeau, an emergency physician and EMS fellow, and discusses his experiences and insights into the field of emergency medicine, mainly focusing on pre-hospital care and the evolving roles of paramedics. He highlights the differences between the US and European models of emergency medical services, the importance of education and training for paramedics, and the critical need for blood management in emergencies. Dr Bilodeau also shares his plans for research and education within the EMS field, emphasising the importance of community buy-in and the need for systemic changes in delivering pre-hospital care.TakeawaysDr Bilodeau is an ER doctor in Maine, completing an EMS Fellowship.He emphasises the importance of education in pre-hospital care.The US EMS model differs significantly from European models, particularly in physician involvement.There is a need for cultural change regarding paramedic roles in the US.Dr Bilodeau advocates for treating and releasing patients in the field when appropriate.He is involved in research on teaching critical skills to paramedics.The conversation highlights the logistical challenges of blood management in emergency care.Dr Bilodeau discusses the potential of using freeze-dried plasma in austere environments.He encourages new practitioners to seek opportunities and engage in projects actively.The finger thoracostomy is presented as a more effective technique than traditional needle decompression.Chapters00:00 Introduction to Dr Sean Bilodeau01:01 Emergency Medicine and EMS Fellowship02:34 Differences in Pre-Hospital Care Models05:31 Reimagining Paramedic Roles11:49 Future Plans and Research in EMS16:34 Global Perspectives on EMS Education21:55 The Importance of Blood in Emergency Care27:21 Challenges in Wilderness Medicine34:15 Advice for New Practitioners in Austere Medicine

This week, Aebhric O'Kelly talks with Dr Derrick Tin, a professor of critical care and director of counterterrorism medicine at Harvard University, and discusses the multifaceted field of disaster medicine. He explains the importance of providing quality care in resource-limited environments and the various pathways for medical professionals to get involved in this speciality. Dr Tin shares his journey from critical care to disaster medicine, emphasising the need for practical training and the psychological aspects of working in disaster scenarios. He also highlights the significance of mentorship and the evolving nature of disaster medicine as a recognised subspecialty.TakeawaysDisaster medicine focuses on providing care in resource-limited environments.Soft skills are crucial for disaster medicine specialists.There are various pathways to enter disaster medicine, including courses and fellowships.Critical care experience is valuable in disaster medicine.Training should include practical, hands-on experiences.Mental health support is essential for disaster responders.Disaster medicine should be integrated into medical school curricula.The Harvard DM Fellowship offers unique resources and training.Networking and collaboration are vital in the disaster medicine community.Future developments in disaster medicine should focus on recognition as a standalone subspecialty.Chapters00:00 Introduction to Disaster Medicine02:57 Understanding Disaster Medicine06:07 Pathways into Disaster Medicine09:14 The Role of Critical Care in Disaster Medicine11:47 Training for Disaster Medicine15:05 The Ideal Disaster Medicine Course18:04 Harvard's Disaster Medicine Fellowship20:57 Experiences in Disaster Response24:13 Psychological Aspects of Disaster Medicine27:05 Contributions to the Field Guide30:03 The Future of Disaster Medicine32:52 Advice for New Practitioners36:10 Involvement in WADEM

This week, we explore various topics related to academic medicine in remote and austere environments that were presented during the Medicine in the Mediterranean conference in February 2025. The discussions include ventilation techniques in challenging settings, the impact of human factors in pre-hospital care, the importance of nursing care, and the complexities of treating critical casualties. We also delve into hyperbaric medicine, paediatric trauma, and the significance of mindset in medical practice. Each segment features insights from experts in their respective fields, providing valuable knowledge for medical professionals working in resource-limited areas.TakeawaysContinuous education is essential for effective patient care.Positive pressure ventilation can impact hemodynamic status.Human factors play a crucial role in pre-hospital care.Needle decompression techniques need proper training and feedback.Empathy in nursing care is vital for building trust with patients.Understanding the environment is key in treating critical casualties.Diving medicine requires awareness of hyperbaric risks and regulations.Urban environments significantly influence paediatric trauma.Mindset can shape a medical provider's legacy and effectiveness.Collaboration and communication are essential in emergency medical services.Chapters00:00 Introduction to the Quorum Podcast05:14 Ventilation in Austere Environments10:01 Human Factors in Pre-Hospital Care17:25 Needle Decompression in Pre-Hospital Care20:09 Nursing Care in Pre-Hospital Environments23:19 Treating Critical Casualties28:19 Hyperbaric Medicine and Diving Accidents33:19 Paediatric Trauma35:13 The Importance of Mindset

This week, Dr Sean Keenan gives the keynote address for the Medicine in the Mediterranean 2025 conference held last week in Malta. He discusses the evolution and current practices of Prolonged Field Care (PFC) in military and austere environments. Dr Sean Keenan discusses the importance of adapting medical practices to meet the challenges of remote and resource-limited settings, emphasising the need for comprehensive training and guidelines. The discussion highlights the difficulties with transitioning from Tactical Combat Casualty Care to Prolonged Field Care, the significance of clinical practice guidelines, and the ongoing efforts to improve emergency medical response in various contexts. This conversation delves into the development and implementation of Prolonged Casualty Care guidelines, focusing on the challenges faced in training and the importance of mastering basic medical skills. The discussion highlights the need for effective logistics, the significance of the golden hour in trauma care, and the evolving nature of warfare that impacts medical practices. The speaker emphasises the importance of continuous education and adapting to operational needs while maintaining sound medical principles. Takeaways Prolonged Field Care has evolved significantly over the past decade. The importance of audience participation in understanding medical terms. Learning from past experiences is crucial in medical practices. The Joint Trauma System collects data to improve best practices. Pre-hospital care is often overlooked in trauma literature. Human physiology remains constant regardless of the environment. Prolonged Field Care addresses the gaps in emergency medical response. Training and equipping personnel is essential for effective care. The transition from Tactical Combat Casualty Care to Prolonged Field Care is vital. Understanding the context of care is key to effective medical response. Prolonged Casualty Care guidelines are evolving to meet modern warfare needs. Curriculum development requires feedback from experienced practitioners. Basic medical skills are crucial for effective, prolonged field care. The golden hour is critical for reducing mortality in trauma cases. Logistics play a significant role in successful medical interventions. Training must adapt to the realities of current combat situations. Understanding human physiology is essential for effective medical care. Expecting casualty care is a new concept that needs training. Continuous education is vital for paramedics and medical personnel. Operational needs drive the development of medical guidelines. Chapters 00:00 Introduction to Prolonged Field Care 07:03 The Evolution of Prolonged Field Care 29:04 Current Practices and Guidelines in Prolonged Field Care 31:55 Prolonged Casualty Care Guidelines Overview 35:49 Curriculum Development and Feedback Process 40:12 Challenges in Prolonged Field Care Training 44:01 Extending the Golden Hour in Trauma Care 49:34 Current Practices and Future Directions in Prolonged Field Care 54:44 Mastering the Basics of Prolonged Field Care 01:00:42 Future Warfare and Operational Considerations

This week, Aebhric O'Kelly talks with a fellow Green Beret, Dr Glenn Barnes, who shares his unique journey from Special Forces to becoming a nursing educator specialising in aerospace and extreme environments. He discusses his military background, the transition to nursing, and his experiences in private military contracting. Dr Barnes emphasises the importance of innovative nursing education, particularly for veterans, and the need for nurses to be equipped to operate in austere environments. His insights reflect a deep commitment to military service and nursing, highlighting the interconnectedness of these fields. In this conversation, Glenn Barnes discusses the innovative nursing education programs he has developed, particularly in wilderness medicine and aerospace nursing. He emphasises the importance of experiential learning and the unique skill sets that nurses gain through these programs. The discussion also covers the challenges of providing prolonged field care in space, the historical context of nursing, and advice for new practitioners entering austere medicine. Barnes highlights the need for research and development in nursing practices for extreme environments and the significance of adapting to local conditions and resources. Takeaways Dr Barnes has a diverse background in military and nursing. He transitioned from infantry to nursing due to job availability. His experiences in the military shaped his nursing career. He emphasises the importance of teamwork in Special Forces. Dr Barnes developed programs to help veterans become nurses. He believes in empowering nurses to think outside the box. His courses focus on survival and disaster nursing. Veterans often struggle to utilise their skills in civilian life. The nursing programs he developed were intensive and rewarding. He aims to prepare nurses for challenging environments. The innovative nursing programs provide unique certifications. Experiential learning builds confidence in nursing students. Nurses play a crucial role in prolonged care in space. Research is needed for nursing practices in extreme environments. Historical perspectives on nursing inform current practices. Nursing education must adapt to new challenges in healthcare. Understanding local practices enhances medical care in austere settings. Nurses are essential for long-term patient care in space missions. Improvisation is key in austere medicine. Collaboration and research will shape the future of nursing. Chapters 00:00 Introduction to Dr Glenn Barnes 02:59 Military Background and Nursing Career 05:58 Transitioning from Military to Nursing 08:59 Experiences in Jump School and Special Forces 11:57 Private Military Contracting and Nursing 14:50 Developing Nursing Programs for Veterans 18:02 Innovative Nursing Education in Austere Environments 20:36 Aerospace and Extreme Environment Nursing 23:49 Challenges of Prolonged Field Care in Space 27:41 Developing Nursing Programs for Extreme Environments 30:43 Historical Perspectives on Nursing and Care 35:07 Advice for New Practitioners in Austere Medicine

This week, Aebhric O'Kelly talks with Dr Hannah Evans who shares her experiences as a rural GP and pre-hospital doctor, discussing her work in remote locations, including Antarctica. She highlights the importance of telemedicine in austere environments and her role in advising the ambulance service in Scotland. Dr Evans also talks about her fellowships in wilderness and humanitarian medicine, her teaching efforts at the University of Aberdeen, and offers advice for new practitioners in the field. Takeaways Dr Evans works as an advisor to the ambulance service in Scotland. She has extensive experience in remote and austere environments. Telemedicine can be effectively utilised in Antarctica. Dr Evans emphasises the importance of wilderness medicine education. She has participated in humanitarian efforts in various countries. The FOM fellowship is a valuable credential for remote medics. Dr Evans is proud of her recent FFRRHH fellowship. Teaching wilderness medicine is crucial for medical students. Networking and following experienced professionals is key for new practitioners. Perseverance is essential in pursuing a career in austere medicine. Chapters 00:00 Introduction to Dr Hannah Evans 02:33 Role of a Pre-Hospital Doctor 08:03 Experiences in Austere Environments 12:18 Telemedicine in Antarctica 16:10 Future of Telemedicine and Humanitarian Applications 20:00 Fellowship of the Academy of Wilderness Medicine 23:05 Fellowship of Remote Rural and Humanitarian Healthcare 26:28 Teaching Wilderness Medicine to Medical Students 30:12 Advice for New Practitioners in Austere Medicine

This week, Aebhric O'Kelly talks with Dennis Jarema from the Prolonged Field Care Working Group. They discuss his journey from military service to nursing, emphasising the importance of prolonged field care in austere environments. They discuss the challenges faced in military medicine, the evolution of medical practices, and the establishment of the Prolonged Field Care Working Group. The conversation highlights the need for seamless integration of nursing care in emergencies and the importance of training and communication in improving patient outcomes. This conversation delves into the evolving nature of mnemonics in prolonged field care, the challenges faced in conducting research in austere environments, and the need for better communication and collaboration among practitioners and researchers. The discussion highlights the importance of mastering basic skills, avoiding training scars, and engaging volunteers to enhance the effectiveness of the Prolonged Field Care Working Group. The speakers emphasise the necessity of practical training and the development of a clearinghouse for sharing knowledge and resources in the field of austere medicine. Takeaways How Dennis' military background shaped his approach to medicine. The transition from Special Forces medic to nursing was driven by a desire for long-term patient care. Nursing provides essential skills for prolonged field care in austere environments. Understanding when to transition from emergency care to nursing care is crucial. The Prolonged Field Care Working Group was established to address gaps in military medical training. Training must include practical demonstrations of prolonged field care techniques. Communication and a common language are vital in multi-agency medical responses. The evolution of medical practices in the field reflects advancements in hospital medicine. There is a need for a combined paramedic-nurse training program in the U.S. Learning from international practices can enhance U.S. military medical training. Mnemonics in prolonged field care must evolve with practice. Research in prolonged field care faces significant challenges. There is a need for better communication between researchers and practitioners. Feasibility studies are crucial for understanding prolonged field care. Collaboration is essential for advancing research in austere medicine. The PFC Working Group plays a vital role in the community. Practical skills training is often lacking in current education. Engaging volunteers is key to the success of the PFC Working Group. Mastering the basics is fundamental for new practitioners. Experience is critical for recognising early signs of patient distress. Chapters 00:00 Introduction to Prolonged Field Care 00:45 Dennis' Military Journey 05:08 Transitioning to Nursing 10:52 The Importance of Nursing in Prolonged Care 17:11 Prolonged Field Care Working Group Origins 20:22 Challenges in Prolonged Field Care 26:35 Evolution of Medical Practices in the Field 29:58 Evolving Mnemonics in Prolonged Field Care 30:57 Challenges in Research for Prolonged Field Care 32:26 Bridging the Gap Between Research and Practice 34:52 The Need for Feasibility Studies 36:18 Collaboration in Prolonged Field Care Research 38:14 Establishing a Clearinghouse for Communication 40:36 Future Directions for the PFC Working Group 42:36 The Role of the PFC Working Group 44:03 Developing Practical Skills in Prolonged Field Care 45:32 Engaging Volunteers in the PFC Community 48:28 Mastering the Basics of Prolonged Field Care 50:55 Avoiding Training Scars in Medical Training 54:50 The Future of Prolonged Field Care Education 55:47 Advice for New Practitioners in Austere Medicine

This week, Aebhric OKelly talks with Michael Templeton, a flight paramedic for International SOS, and shares insights into his role, training, and experiences working in Guyana. He discusses the daily routines of a flight paramedic, the importance of training and qualifications, and the challenges faced in a tropical environment. Michael emphasises the need for confidence and leadership skills in emergency medical services and highlights the significance of postgraduate education in making informed decisions in critical situations. He also addresses safety concerns in Guyana and the measures taken to mitigate risks. In this conversation, Michael Templeton shares his extensive experiences in austere medicine, focusing on safety protocols, real-life rescue operations, and his response to the Ebola outbreak in Sierra Leone. He emphasises the importance of teamwork, adaptability, and continuous learning for medical professionals working in challenging environments.   Takeaways Michael Templeton has over six years of experience as a flight paramedic. He works in Guyana, primarily in oil and gas operations. A typical day includes meetings, briefings, and equipment checks. There is only one paramedic on duty at a time. Working in a busy EMS is essential for gaining confidence. Postgraduate education aids in decision-making for complex cases. Safety measures are crucial when working in high-risk environments. Paramedics must be prepared to make quick decisions. Training in various medical and rescue techniques is essential. Mitigating risks is key to ensuring safety in Guyana. Safety protocols are crucial in austere environments. Real-life rescue operations can be unpredictable and challenging. Injured individuals may require improvised care in remote locations. Understanding the risks and limitations of rescue missions is essential. Ebola response requires strict hygiene and safety measures. Teamwork and communication are vital in emergency situations. New medics should learn from experienced colleagues in the field. Adaptability is key when working in austere conditions. Continuous learning and skill development are important for medical professionals. Building relationships with local staff can enhance operational effectiveness.   Chapters 00:00 Introduction to Flight Paramedicine 02:55 A Day in the Life of a Flight Paramedic 06:10 Training and Qualifications for Flight Paramedics 08:53 Preparing for a Career in Flight Paramedicine 11:54 The Importance of Postgraduate Education 14:57 Safety and Risks in Guyana 25:55 Safety Protocols in Austere Environments 26:42 Real-Life Rescue Operations 38:59 Ebola Response in Sierra Leone 47:45 Advice for New Medics in Austere Medicine

This week, Aebhric OKelly talks with Daniele Manno, a graduate of the CoROM Remote Paramedic programme. He shares his unique journey from being a pilot to a paramedic, emphasising the importance of wilderness medicine and survival training. He discusses his experiences in clinical practice, particularly in trauma care, and reflects on the challenges and rewards of teaching remote life support courses. Daniele also highlights the need for a broader understanding of medical practices in austere environments and offers advice for new medics entering the field.   Takeaways Daniele transitioned from a 30-year career as a pilot to medicine at age 50. He emphasises that survival skills alone are insufficient without medical knowledge. Wilderness medicine training is crucial for those leading outdoor activities. Daniele's remote life support courses cover a wide range of medical situations. He believes curiosity is essential for deeper learning in medicine. His clinical experience in Africa provided hands-on learning opportunities. Daniele advocates for the recognition of paramedics in Italy's healthcare system. He stresses the importance of being broad-minded in austere medicine. Daniele's teaching aims to inspire students to pursue further medical education. He encourages new medics to be prepared for diverse medical challenges.   Chapters 00:00 From Pilot to Paramedic: A Unique Journey 09:13 The Importance of Wilderness Medicine 15:35 Transitioning to Remote Paramedic Training 27:38 Experiences in Clinical Practice 31:48 Preparing for the Future of Medicine

This week, Aebhric O'Kelly reflects on the highlights of 2024, showcasing insights from various guests who have contributed to the field of austere and remote medicine. The conversation covers prolonged casualty care, the importance of guerrilla medicine, and the challenges medics face in rural settings. The guests share their experiences and advice for new medics, emphasising the need for continuous learning and adaptability in the face of unique medical challenges. Guests: Mike Turconi Dr Sean Keenan Dr Jaime Riesberg CJ Malcolm Antonio from EuroMedic Dr Jørgen Melau Dr Peter Anders Christiensen TacMedNorth from Ukraine Takeaways 2024 has seen over 30,000 downloads from 43 countries. Austere medicine requires a different approach than traditional settings. Continuous learning is essential for medical professionals. Guerrilla medicine is becoming increasingly relevant in modern conflicts. Training in prolonged casualty care is crucial for medics in the field. Hyperthermia management is vital in cold operational settings. Rural populations often lack access to timely medical care. Improvisation is key in austere medical environments. Education is fundamental to improving medical practices worldwide. New medics should always strive to improve their knowledge and skills. You have to be prepared to improvise. Chapters 00:00 Introduction to the CoROM Podcast 00:42 Highlights from 2024 Guests 06:09 Insights on Austere Medicine 09:29 Prolonged Casualty Care vs. Prolonged Field Care 13:12 The Importance of Guerrilla Medicine 15:10 Hyperthermia in Operational Settings 18:40 Challenges in Rural and Austere Medicine 20:27 Nordic Special Operations Combat Medic Program 23:09 Training Medics in Ukraine 27:24 Final Advice for New Medics

This week, Aebhric O'Kelly talks with Nick Hill about his extensive experience in military nursing, detailing his journey from the New Zealand Defence Force to the Danish military. He discusses the roles he has held, the challenges faced in various environments, and the importance of improvisation in medical practice. Nick emphasises the need for continuous learning and adaptation in austere medicine, drawing insights from his Austere Emergency Care course participation. He also highlights the cultural differences between military practices in different countries and the importance of collaboration in improving medical care. Takeaways Soldering is a universal concept across different militaries. Improvisation is crucial in austere medical settings. Continuous learning is essential for medical professionals. Cultural differences impact military medical practices. The importance of teamwork in emergency care. Adaptation and improvisation can enhance clinical practice. Engaging civilians in medical training is vital. Nordic countries show a strong commitment to medical readiness. Understanding logistics is key in prolonged field care. Seek knowledge from diverse sources for better practice. Chapters 00:00 Introduction to Nick Hill's Military Journey 03:12 Roles and Responsibilities in New Zealand's Military 05:57 Transitioning to Denmark and Cultural Differences 09:00 Experiences in Australia and Unique Challenges 11:56 Austere Emergency Care Course Insights 15:06 Improvisation in Medical Practice 18:08 Learning from Diverse Medical Environments 20:53 Advice for New Medics in Austere Medicine

This week, Aebhric O'Kelly talks with Dr Jørgen Melau. They discuss the intricacies of providing prolonged field care (PFC) in Arctic environments. They emphasise the importance of knowledge over gear, the challenges of managing cold casualties, and the necessity of shelter and improvisation. The discussion also covers protocols for PFC, the difficulties of vapour barriers, transportation strategies, and future developments in Arctic medical care. Dr Melau provides valuable advice for new medics interested in working in cold environments, highlighting the need for comfort and experience in such conditions.   Takeaways Knowledge is more vital than the actual gear. Training should focus on the person, not just products. Shelter is vital for casualty care in the Arctic. Improvisation can save lives in cold environments. Condensation is a considerable problem in cold weather operations. Breathable fabrics could improve vapour barriers. Keeping hands warm is vital for medics in cold environments. You must be comfortable in the cold before being a medic. Training in cold environments is essential for medics. Human performance is key in prolonged care situations.   Chapters 00:00 Introduction to Arctic Prolonged Field Care 01:10 The Importance of Knowledge Over Gear 07:04 Managing Cold Casualties in the Arctic 11:37 Shelter and Improvisation Techniques 17:00 Protocols for Prolonged Field Care 23:02 Challenges of Vapor Barriers and Heating 30:03 Transportation and Evacuation Strategies 34:48 Future Developments in Arctic PFC 44:58 Advice for New Medics in Cold Environments

This week, Aebhric O'Kelly talks with Phill Clark about his journey from a career in product management to becoming involved in medical education at the Masters of Austere Critical Care. He discusses the importance of practical skills in medicine, his role in improving student experiences, and the unique challenges adult learners face. Phil also highlights advancements in digital microscopy and AI, emphasising the collaborative potential of technology in healthcare. He concludes with advice for new medics, stressing the value of hands-on experience and the offerings of CoROM.   Takeaways Phil transitioned from product management to medical education during COVID. He emphasizes the importance of practical skills in medicine. Phil's role involves improving student experiences in the Masters programme. He advocates for a centralised communication system for student inquiries. Phil believes in the value of individualised responses to student needs. CoROM's student body is generally older and more experienced. Lifelong learning is crucial for personal and professional growth. Advancements in AI and digital microscopy can enhance healthcare delivery. Phil stresses the importance of hands-on experience for new medics. He encourages exploring Co-ROM's courses for aspiring medical professionals.   Chapters 00:00 Introduction to Phil Clark 05:10 Phil's Journey to Medical Education 13:28 Improving Student Experience 18:52 The Importance of Individualized Responses 25:27 Lifelong Learning and Experience 38:11 Advice for New Medics

This week, Aebhric O'Kelly talks with Dr David Newman, an aerospace medicine expert who shares his extensive experience in military aviation, the evolution of fighter aircraft, and the future of human pilots in an increasingly automated world. He discusses his recent presentation at the Taipei International Military Medicine Forum, the importance of aerospace medicine education, and the challenges posed by AI in academic publishing. Takeaways • Dr Newman has a rich background in military aviation and aerospace medicine. • The F-18 is considered one of the best aircraft to fly. • The future of piloting may shift towards AI and drones. • Ejection from aircraft can lead to hidden injuries like vertebral fractures. • Aerospace medicine education is crucial for both civil and military doctors. • AI poses challenges in maintaining the integrity of academic publishing. • Crazy Socks for Docs raises awareness for mental health in healthcare professionals. • Mental health issues in healthcare are often overlooked. • Interest in a subject is key to completing a PhD. • The evolution of fighter jets reflects advancements in technology.   Chapters 00:00 Introduction to Dr David Newman 02:59 Aviation Medicine and Military Experience 06:01 The Evolution of Fighter Aircraft 08:52 The Future of Human Pilots in Aviation           11:59 Insights from the Taipei International Military Medicine Forum 15:04 Aerospace Medicine Education and Training 17:51 The Role of AI in Academic Publishing 20:58 Crazy Socks for Docs: A Movement for Mental Health 23:53 Advice for New Medics in Aerospace Medicine

This week, Aebhric O'Kelly talks with Tanguy Bader, a second-year BSc Paramedic student, who shares his journey in paramedicine, discussing his experiences in New Orleans EMS, the importance of continuous learning, and his aspirations for the future. He emphasises the significance of basic skills in emergency medicine, the value of patient interactions, and his desire to contribute to international healthcare efforts. Tanguy reflects on his educational experiences and the impact they have on his clinical practice, highlighting the importance of being a compassionate and competent clinician.   Takeaways •   Continuous learning is essential in paramedicine. •   Basic skills are crucial for effective patient care. •   Patient interactions provide valuable insights into care. •   Paramedic education enhances clinical practice significantly. •   Experience in the field complements academic learning. •   Building relationships with partners is vital in EMS. •   A focus on patient dignity and respect is paramount. •   International work offers unique challenges and rewards. •   Communication and teamwork are key in emergency situations. •   Embracing technology can aid in overcoming learning challenges.   Chapters 00:00 Introduction to Tanguy Bader and His Journey 03:10 Learning and Growth in Paramedic Education 09:32 Pathway to Becoming a Paramedic 17:11 Future Aspirations in Paramedicine 20:49 The Importance of Patient Interaction 27:00 Experiences in New Orleans EMS 30:37 Advice for New Paramedics 33:45 Conclusion and Reflections

This week, Aebhric O'Kelly talks with Katie Beck, director of the Diploma of Tropical Nursing at the London School of Hygiene and Tropical Medicine, who shares her extensive experiences in global health and expedition medicine. She discusses the challenges nurses face in low-resource settings, the importance of cultural competence, and the evolving role of nurses in global health. Katie emphasises the significance of the Diploma of Tropical Nursing in preparing healthcare professionals for work in diverse environments and highlights the need for advocacy and innovation in nursing education. Takeaways • Katie Beck has a diverse background in nursing and global health. • Expedition medicine offers unique challenges and experiences. • Cultural competence is crucial in healthcare delivery. • Nurses are vital in global health, delivering 80% of care. • The Diploma of Tropical Nursing prepares nurses for low-resource settings. • The PDTN fosters a global network of healthcare professionals. • Innovative approaches in nursing education are essential for future challenges. • Partnerships in healthcare education enhance mutual benefits. • Critical thinking is essential, but doubt should not impede action. • The future of nursing includes advocacy and leadership in global health. Chapters 00:00 Introduction to Katie Beck and Her Work 02:50 Experiences in Expedition Medicine 06:00 Challenges in Austere Nursing 11:02 Cultural Competence in Healthcare 15:05 The Role of Nurses in Global Health 19:15 The Diploma of Tropical Nursing (DTN) 23:00 Future of the DTN and Global Health 33:53 Advice for New Medics and Nurses

This week, Aebhric O'Kelly talks with Mike Morrow, the CoROM BSc Remote Paramedic programme coordinator, on his journey from being a paramedic to evaluating organs for transplantation. He discusses the unique challenges faced in emergency medical services, particularly in Africa, and highlights the dedication of students in the BSc Remote Paramedic Programme. Morrow emphasises the importance of experience in austere environments and compares the training and practices of U.S. paramedics with those of BSc graduates. He provides valuable insights and advice for new medics and nurses starting their careers. Takeaways • Mike Morrow evaluates hearts and lungs for organ transplantation. • He has a rich background in paramedic training and critical care. • The BSc Remote Paramedic Program offers unique opportunities for students. • Students are dedicated to helping in austere settings. • There needs to be more EMS in many African countries. • Experience in austere environments is crucial for paramedics. • Morrow emphasises the importance of adaptability in emergency care. • The programme prepares students for real-world challenges in healthcare. • Morrow encourages new medics to gain as much experience as possible. Chapters 00:00 Introduction to Mike Morrow 05:53 Transitioning to Academia and Teaching 14:22 Challenges in African Emergency Medical Services 19:28 Comparing U.S. and BSc Paramedic Practices 24:38 Prolonged Care in Austere Environments 29:46 Advice for New Medics and Nurses

This week, Aebhric, John Clark and Emmanuel Acheampong discuss a new collaboration in Kumasi, Ghana. The College is creating a collaboration with Komfo Anokye Teaching Hospital to enhance medical education and training. They discuss the hospital's capabilities, the emergency department's operations, the triage system, and the potential for student placements and training initiatives. The discussion highlights the importance of building sustainable relationships and the shared challenges faced in healthcare across different regions. https://kath.gov.gh/ Takeaways • The visit aims to explore collaboration opportunities with Komfo Anokye Teaching Hospital. • The hospital has a wide range of departments, including emergency medicine. • The emergency department has evolved significantly over the years. • Triage is a critical component of patient flow in the emergency department. • There is a growing emphasis on training and certification for healthcare professionals. • The collaboration will provide advanced clinical experiences for students. • Building relationships is essential for successful partnerships in healthcare. • The hospital aims to implement BLS and ACLS training for all staff. • Future plans include establishing a sustainable relationship that benefits both organisations. Chapters 00:00 Introduction and Context of the Visit 04:04 Emergency Department Insights 09:12 Triage System and Patient Flow 11:31 Collaboration Opportunities and Student Placements 15:06 Training and Certification Initiatives 17:08 Future Plans and Sustainable Relationships 19:01 Advice for New Medical Professionals

This week, Aebhric talks with Anke Krug, who is a community nurse in Nunavut, Canada, and shares her experiences and challenges in providing healthcare in a remote Arctic environment. She discusses the complexities of medevac nursing, the environmental considerations for patient care, and the importance of collaboration and communication in remote healthcare settings. Anke also highlights the evolving roles in nursing and paramedicine, the need for ongoing training and education, and the significance of patient assessment and decision-making in austere conditions. The conversation concludes with advice for new nurses entering the field. Takeaways The Arctic presents unique challenges for healthcare delivery. Medevac nursing requires careful preparation and environmental awareness. Collaboration with other healthcare professionals is essential. Telehealth plays a crucial role in remote patient care. Nursing roles are evolving to include advanced paramedic skills. Patient assessment is critical in making treatment decisions. Guidelines for prolonged field care can enhance patient outcomes. Technology is improving healthcare delivery in remote areas. Community engagement is essential for mental well-being in harsh environments. New nurses should seek mentorship and focus on continuous learning. Chapters 00:00 Introduction to Community Nursing in Nunavut 03:00 The Challenges of Medivac Nursing 05:54 Environmental Considerations in Patient Care 08:59 Collaboration and Communication in Remote Healthcare 12:12 Evolving Roles in Nursing and Paramedicine 14:58 Training and Education for Remote Healthcare 18:05 Patient Assessment and Decision Making 20:59 Utilising Guidelines for Prolonged Field Care 23:52 Technology and Innovations in Remote Medicine 27:09 Community Engagement and Fun in Nunavut 30:01 Advice for New Nurses in Austere Environments

This week, Aebhric OKelly speaks with Rhod Jordan, a remote paramedic working in Kurdistan, about the intricacies of the Medical Emergency Response Plan (MERP). Rhod shares his experiences and insights on the importance of planning, communication, and training in emergency medical situations. He emphasises the need for thorough assessments of local medical facilities and the significance of building relationships with local healthcare providers. The discussion also covers the training and development of medical teams in austere environments and advice for new medics entering the field. Takeaways The MERP is essential for efficient emergency response. Communication protocols are critical in emergencies. Regular training and drills improve readiness. Local medical facilities should be audited before use. Building relationships with local healthcare providers is vital. Documentation and evaluation are vital to improving plans. New medics should seek guidance from experienced professionals. Understanding local laws regarding medical supplies is crucial. Prolonged field care concepts are essential in remote areas. Utilising technology can enhance patient care and communication. Chapters 00:00 Introduction to Remote Paramedicine in Kurdistan 01:21 Understanding the Medical Emergency Response Plan (MERP) 03:37 Components of a Successful MERP 15:06 Communication and Coordination in Emergencies 22:48 Evaluating Local Medical Facilities 36:20 Training and Development for Medical Teams 41:39 Advice for New Medics in Austere Environments

This week, Aebhric chats with Dr Peter Anders Christiansen (PAC), a former senior medical officer in the Danish Special Forces, who discusses his work in PTSD treatment using Stellate Ganglion Block (SGB) and his role in developing the Nordic Special Operations Combat Medic Course. He shares insights on the effectiveness of SGB for veterans suffering from PTSD, the challenges of medical training in NATO countries, and the future of special operations medical education in Europe. PAC also offers valuable advice for new medics entering austere medical environments. safenordicsolutions.com stellatumklinikken.com Takeaways SGB is effective for treating hyperarousal in PTSD. The amygdala's reset can significantly improve PTSD symptoms. The Nordic Special Operations Combat Medic Course was developed to standardise training. Collaboration among Nordic countries was vital to creating the NSOC. Future funding and strategic changes will impact medical training in Europe. Interoperability among NATO countries is essential for effective medical support. Cultural differences affect the implementation of medical training across nations. New medics must adapt to austere medical environments. Improvisation is crucial in emergency medical situations. The importance of continuous education and recertification for medics. Chapters 00:00 Introduction to Dr. Peter Anders Christiansen 01:31 Innovative PTSD Treatment: Stellate Ganglion Block 12:34 The Nordic Special Operations Combat Medic Course 34:34 Future of NSOCM and European Medical Training 49:27 Advice for New Medics in Austere Medicine

This week, Aebhric O'Kelly talks with Dr Jamie Riesberg, who created the separation of Prolonged Casualty Care (PCC) from Prolonged Field Care (PFC). Dr Riesberg has extensive experience in military medicine, focusing on the evolution of prolonged field care and the transition from the Global War on Terror (GWOT) to future conflicts. He emphasises the importance of adapting medical training to current battlefield realities, including lessons from Ukraine. Dr Riesberg advocates for a shift in mindset towards PCC and the need for continuous hands-on experience for medics. They also discuss the challenges posed by policy and training limitations, urging a more robust approach to medical care in combat situations. Takeaways Prolonged field care is essential for future military operations. Past conflicts influence the evolution of military medicine. NATO plays a crucial role in standardising medical training. Lessons from Ukraine highlight the need for adaptability in medical care. Medics must be prepared for prolonged care situations. The environment significantly impacts medical decision-making. Continuous training and hands-on experience are vital for medics. Policy changes are necessary to enhance medical training opportunities. Expectant casualty management is a growing concern in military medicine. Curiosity and creativity are critical traits for success in austere medicine. Chapters 00:00 Introduction to Dr. Jamie Riesberg 02:54 The Evolution of Military Medicine 05:48 The Importance of Prolonged Field Care 09:02 Transitioning from GWAT to LISCO 12:04 The Role of NATO in Medical Training 15:00 Lessons from Ukraine and Future Conflicts 17:49 The Concept of Prolonged Casualty Care 20:51 Challenges in Training and Policy 24:05 The Future of Medical Care in Combat 27:03 Advice for New Medics in Austere Medicine

This week, Aebhric O'Kelly talks with Eric Holmstrom and Laszlo Hegedus about creating a new faculty within CoROM. They discuss their recent activities, including organising law enforcement competitions and teaching various medical courses. They highlight the importance of hands-on training and the need for continuous learning in operational medicine. The conversation also touches on the upcoming developments at the college, such as the establishment of the Faculty of Operational Medicine and the implementation of new monitoring devices for patient care. They emphasise the importance of documentation and research in improving medical practices. The discussion concludes with advice for healthcare professionals starting their careers. keywords operational medicine, law enforcement competitions, medical courses, hands-on training, continuous learning, college developments, Faculty of Operational Medicine, monitoring devices, documentation, research, advice for healthcare professionals Takeaways Hands-on training and continuous learning are essential in the field of operational medicine. The college is establishing the Faculty of Operational Medicine to bring together subject matter experts and advance the field. Implementation of new monitoring devices and documentation systems can improve patient care and facilitate research. Healthcare professionals should be bold and ask questions, seek learning opportunities, and get involved in patient care. Interoperability and adherence to evidence-based guidelines are crucial in providing quality medical care. Chapters 00:00 Introduction and Recent Activities 03:16 Teaching Experiences and Motivated Students 06:05 Improvisation and Moulage Training 09:20 The Importance of Tropical Medicine 13:02 The Growing Momentum of Ultrasound Training 17:59 The Need for Prolonged Field Care and AEC Courses 19:39 The Faculty of Operational Medicine 22:16 Implementing New Monitoring Devices and Documentation Systems 27:29 NEAMT Certification and Offering Additional Courses 29:39 Advice for Healthcare Professionals Starting Their Careers

Cole Shaver and Graydon Ratushny are paramedics working in British Columbia who share their experiences working in Kibosho District Hospital in Moshi, Tanzania, as part of the Austere Critical Care Master's program. They discuss the challenges of practising medicine in a resource-limited setting and the importance of improvising and adapting clinical skills to the local context. They highlight basic clinical assessments, such as percussion and auscultation, and the value of non-technical skills in making diagnoses and providing care. They also discuss the social determinants of healthcare and the impact of a user-pay system on patient access to medical services. The conversation explores the themes of telehealth and remote health assessments, the importance of old-school clinical skills, the resilience of patients in resource-limited settings, the use of CPAP in rural healthcare, the value of the CoROM Field Guide, and the benefits of international healthcare experiences. takeaways Adapting clinical skills to a resource-limited setting is crucial for providing effective care. Basic clinical assessments, such as percussion and auscultation, can be valuable tools without advanced diagnostic equipment. Non-technical skills, such as observation and clinical gestalt, play a significant role in making diagnoses and guiding treatment decisions. The social determinants of healthcare, including a user-pay system, can profoundly impact patient access to medical services. Telehealth and remote health assessments are shaping the future of healthcare, allowing for transmitting imaging and audio findings to specialists in established facilities. Old-school clinical skills, such as physical assessments and clinical signs, are underappreciated in Western medicine but highly relevant in resource-limited settings. Patients in rural and remote areas are often more resilient than expected, and healthcare providers can take a step back and gather more information before intervening. CPAP devices can effectively manage respiratory distress in resource-limited settings, and collaborative teaching and learning between healthcare professionals from different backgrounds is invaluable. The CoROM Field Guide is a valuable resource for remote and rural clinicians. It provides essential information and prompts when data connectivity is limited. International healthcare experiences provide a broader perspective and appreciation for different healthcare systems and practices, fostering collaboration and knowledge sharing. Chapters 00:00 Introduction and Background 03:00 Adapting Clinical Skills in a Resource-Limited Setting 08:34 The Value of Basic Clinical Assessments 13:42 The Role of Non-Technical Skills in Diagnosis 20:04 The Impact of Social Determinants on Healthcare Access 29:48 The Future of Healthcare: Telehealth and Remote Assessments 32:23 The Value of Old School Clinical Skills in Resource-Limited Settings 35:35 Resilience of Patients in Rural and Remote Areas 39:23 CPAP: A Game-Changer in Resource-Limited Healthcare 52:51 The Quorum Field Guide: A Must-Have for Remote Clinicians 56:11 The Benefits of International Healthcare Experiences

This week, Aebhric O'Kelly talks with Ronin's founder, Timm Smith, who shares his journey from being a lawyer to becoming a close protection officer and paramedic. He discusses the importance of being a whole bodyguard, protecting clients from external and internal threats. Tim emphasises the need for excellence, reality, and truth in the close protection industry. He also highlights the value of training paramedics to be close protection officers and vice versa. The conversation touches on the impact of Gregorii Tsekmistrenko's death, a Ronin graduate, and the importance of humility and learning from mistakes in austere medicine. https://www.ronin.co.za/ Takeaways Being a whole bodyguard means protecting clients from both external and internal threats. Excellence, reality, and truth is essential in the close protection industry. Training paramedics to be close protection officers and vice versa is a valuable career path. Humility and learning from mistakes are crucial in austere medicine. Chapters 00:00 Introduction and Background 07:11 From Law to Close Protection 10:29 Becoming a Paramedic 17:33 Founding Ronin: A Centre of Excellence 24:23 The Connection to Malta 28:30 Training Paramedics in Close Protection 35:02 Remembering Gregorii Tsekmistrenko 38:03 Advice for New Medics

This week, Aebhric O'Kelly talks with John Clark, the College's Executive Dean, about the new 2024-2025 academic year. They discuss the recent developments and plans for the college. John discusses the college's collaborations with organisations like WMS and IBSC and upcoming trips to Ghana and Tanzania. He also mentions the expansion of the college's facilities and the launch of a peer-reviewed journal. The conversation concludes with advice for healthcare professionals starting their careers in austere medicine. takeaways The college has launched the doctorate in health studies and has seen growth in the bachelor's program in remote paramedic practice. The Master's in Austere Critical Care program is also growing, and the college is launching a new Master's in Global Health program. The college collaborates with organisations like WMS and IBSC and is working to expand the reach of paramedic certifications. Upcoming trips to Ghana and Tanzania will focus on establishing new clinical sites and improving existing ones. The college is expanding its facilities and launching a peer-reviewed journal called the Journal of Improvised Medicine. Advice for healthcare professionals starting their careers in austere medicine is to seek education and continuously improve their skills. Chapters 00:00 Introduction and Overview 01:03 Recent Developments and Plans for the College 02:30 Expanding Programs and Collaborations 04:52 Trips to Ghana and Tanzania 10:41 Facility Expansion and Peer-Reviewed Journal 18:30 Advice for Healthcare Professionals in Austere Medicine

This week, Aebhric OKelly interviews Bill Vasios, a physician assistant who started as an 18 Delta and had several other 18 series jobs. Bill is pursuing a PhD in education focusing on instructional design and technology. He is also doing a simulation fellowship at East Carolina University. They talk about online learning, designing a perfect online learning system, the challenges of teaching in the medical field, and the importance of credible sources in education. Takeaways Bill is a physician assistant with a background in the military, having served as an 18 Delta and held other 18 series jobs. He is pursuing a PhD in education, focusing on instructional design and technology. Bill discusses the challenges and benefits of online learning and the importance of credible sources in education. He also discusses the need for adaptive and interactive learning systems in medicine. Stay thirsty for knowledge and continuously learn throughout your career. Ultrasound is a valuable tool for Special Forces medics, but training and sustainment are crucial. Hands-on training and mentorship are essential for developing ultrasound skills. Effective teaching requires authenticity, care, and adapting to individual learning needs. The art of teaching lies in respectfully challenging and guiding students to improve their skills. Access to ultrasound equipment and regular scanning practice are necessary for maintaining competence. The ability to compare normal and injured scans is valuable for identifying abnormalities. Being surrounded by excellent people raises everyone's skills and abilities. Chapters 00:00 Introduction and Correction of Name 01:31 Bill's Background and Current Pursuits 08:18 Designing an Adaptive Learning System 12:22 The Challenges of Teaching in the Medical Field 14:12 The Future of Online Learning in the Medical Field 16:24 Balancing Online and Face-to-Face Learning 18:12 The Importance of Credible Sources in Education 23:51 Creating Curriculum for Soft Medics 24:29 Getting to Know Bill Vasio 30:12 Bill's Military Background and Transition to PA 33:39 Bill's Military Journey and Learning Code 35:10 Selection and Robin Sage 38:52 Becoming a PA and Returning to SF 40:47 The SOLCUS Program and Ultrasound in SF 43:04 Special Operator Level Clinical Ultrasound Programme and Advancements in Ultrasound 45:00 Sustaining Ultrasound Skills in 18 Delta Medics 49:04 Advice for New Medics and the Importance of Continuous Learning 53:05 The Art of Effective Teaching and Mentoring 56:30 Challenges of Ultrasound Training and Sustainment 01:05:00 Conclusion and Final Thoughts

This week, Aebhric O'Kelly talks with Antonio from European Medics about their work and focus on guerrilla, austere, and remote medicine. European Medics started as a community of passionate individuals in emergency medicine and has grown to focus on education and enhancing medicine. European Medics is currently working on creating training material and educative resources for their Advanced Guerrilla First Responder (AGFR) course. European Medics (EURMED) is focused on providing evidence-based guidance in unconventional and guerrilla medicine. Guerrilla medicine overlaps with other fields, such as wilderness medicine, medical support for irregular warfare, and disaster relief. The goal is to be better prepared for future conflicts and disasters and to save lives. Takeaways European Medics started as a community of passionate individuals in emergency medicine and has grown to focus on education and enhancing medicine. They are currently working on creating training material and educative resources for their Advanced Guerrilla First Responder (AGFR) course. European Medics has a podcast with multiple shows, including medical basics, field clinic, and long-format discussions with subject matter experts. Their goal is to provide training and education in austere and remote medicine to enhance the capabilities of healthcare providers in resource-limited environments—European Medics evidence-based guidance in unconventional and guerrilla medicine. EURMED has published a paper on gorilla medicine and plans to publish more papers on the topic. EURMED aims to be a neutral ground for the medical community to exchange experiences and provide expert medical education. The future of guerrilla medicine is seen as an integrated part of forward medicine, focusing on providing care to civilians affected by conflicts. Guerrilla medicine overlaps with other fields, such as wilderness medicine, medical support for irregular warfare, and disaster relief. The goal is to be better prepared for future conflicts and disasters and to save lives. Chapters 00:00 Introduction and Background 03:10 European Medics: Community and Education 06:12 The Advanced Guerrilla First Responder Course 09:02 Podcast: Medical Basics and Field Clinic 23:02 Publishing Concepts and Lessons Learned in Ukraine 27:11 The Future of European Medics 29:13 European Medics: A Neutral Ground for Medical Education 31:37 Expanding European Medics to the United States 36:48 Guerrilla Medicine and Overlapping Fields 41:37 The Clandestine Nature of Guerrilla Medicine 44:45 Preparing for Future Conflicts and Disasters 46:51 Advice for New Medical Professionals

This week, Aebhric talks with Dr Alastair Fraser, chair of the faculty advisory board for the Faculty of Remote Rural and Humanitarian Health care for the Royal College of Surgeons of Edinburgh, and discusses his diverse medical career and experiences in remote and rural areas. He shares stories from his time in the Antarctic, Nigeria, and with Shell, highlighting the challenges and unique situations he encountered. Dr Fraser also discusses the importance of mental health support for medics in remote locations and the need for ongoing training and resources. The conversation discusses the creation and purpose of the Faculty of Rural Remote Humanitarian Health, a specialised area under the Royal College of Surgeons of Edinburgh. The faculty aims to provide training and recognition for healthcare professionals in remote, rural, and humanitarian settings. It addresses the challenges of delivering healthcare in these areas and seeks to improve the quality of training and competence. The conversation also highlights the importance of community and networking among professionals in these fields. The faculty offers fellowship and membership to individuals who have demonstrated competence and contribution to the field. Takeaways Dr Alastair Fraser has had a diverse medical career, working in remote and rural areas and with Shell in various locations. He emphasises the challenges and unique situations in remote healthcare, where medics are often asked to handle various medical issues. Dr Fraser highlights the importance of mental health support for medics in remote locations and the need for ongoing training and resources. He discusses the potential benefits of incorporating ultrasound devices into the toolkit of offshore medics but acknowledges the challenges in implementing this due to company policies and liability concerns. The Faculty of Rural Remote Humanitarian Health is a specialised area under the Royal College of Surgeons of Edinburgh that provides training and recognition for healthcare professionals working in remote, rural, and humanitarian settings. The faculty addresses the challenges of delivering healthcare in these areas and aims to improve the quality of training and competence. Membership in the faculty is open to anyone interested in the field, not just doctors or medics. The faculty plans to offer more online courses that cover various skills needed in remote, rural, and humanitarian healthcare. The faculty is voluntary and relies on volunteers and funding to operate. Networking and community-building among professionals in these fields are important for sharing ideas and experiences. The faculty is working towards providing educational credits and accreditation for its courses. Healthcare professionals interested in working in austere environments should seek training, talk to experienced professionals, and develop skills in working under pressure and uncertainty. Chapters 00:00 Introduction and Background 02:10 Experiences in the Antarctica 03:00 Challenges and Unique Situations in Remote Healthcare 08:05 Limited Medical Resources in Remote Locations 15:23 Importance of Mental Health Support for Medics 20:21 Implementing Ultrasound for Offshore Medics 21:10 Introduction to the Faculty of Rural Remote Humanitarian Health 23:50 Challenges of Delivering Healthcare in Remote and Rural Areas 27:35 Membership and Community in the Faculty 33:57 Expanding Online Courses for Remote Healthcare 39:02 The Humanitarian Healthcare Course and Accreditation 43:47 Advice for Healthcare Professionals in Austere Environments

This week, Aebhric talks with Frida Svahn, a nurse from Sweden, who discusses her experiences teaching medical training in various countries and her work with the Swedish Civil Contingencies Agency (MSB). She shares her journey from serving in the Swedish Armed Forces to becoming a nurse and her passion for working in austere environments. Frida highlights the importance of training the trainers and its impact in countries like Ukraine. She also mentions the upcoming National Seminar Exercise in Sweden and the role of MSB in civil defence and NATO. Frida advises new healthcare professionals interested in working in austere environments to invest in good courses, build a network, and stay motivated.   Takeaways Teaching medical training in austere environment is a rewarding experience that allows healthcare professionals to make a difference in countries like Ukraine. MSB plays a significant role in civil defence and NATO, providing training and expertise in emergency response and crisis management. Investing in good courses, building a network, and staying motivated are essential for healthcare professionals working in austere environments. Training the trainers is a force multiplier that spreads knowledge and skills to a larger population. Sweden's upcoming National Seminar Exercise will involve multiple nations, focusing on casualty move and patient flow management.

This week, Aebhric O'Kelly talks with Dr John Quinn and Eirik Holmstrøm, who all went to Ukraine to teach the Damage Control Resus Ukraine (DCRU) course. They discuss the curriculum, the use of clinical practice guidelines (CPGs), and the importance of access to blood in the pre-hospital setting. They highlight the collaboration with Tactical Medicine North and the professional partner forces in Ukraine. The hosts also mention the Defence Health Administration's (DHA) role and the resources on the DHA website and app. The conversation emphasises evidence-based practices and knowledge exchange's significance in improving military medicine. The conversation focuses on the challenges and solutions in Ukraine's implementation of damage control resuscitation (DCR). The speakers discuss the need for interoperability in large-scale combat operations (LSCO) and the importance of rethinking traditional medical practices. They highlight the limitations of blood transfusion in the field and the need for a logistic system to support the transportation of blood. The conversation also covers training Ukrainian combat medics in advanced skills such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and ultrasound. The speakers emphasise the importance of continuous learning, adapting to failures, and the potential for DCR to increase combat effectiveness in Ukraine. Keywords Damage Control Resus Ukraine, DCRU, curriculum, clinical practice guidelines, CPGs, pre-hospital setting, blood access, Tactical Medicine North, partner forces, Defence Health Administration, DHA, evidence-based practices, military medicine, damage control resuscitation, interoperability, large-scale combat operations, blood transfusion, logistic system, training, combat medics, REBOA, ultrasound, continuous learning, combat effectiveness Takeaways The DCRU course in Ukraine focused on damage control resuscitation in the pre-hospital setting. The curriculum was based on clinical practice guidelines (CPGs) from the Defence Health Administration (DHA). Access to blood and blood components was highlighted as crucial in effective care. Collaboration with Tactical Medicine North and professional partner forces in Ukraine was instrumental in the course's success. The DHA website and app provided valuable resources for learning and reference in austere environments. The exchange of knowledge and lessons learned is essential for improving military medicine. Implementing damage control resuscitation in large-scale combat operations requires interoperability and a logistic system to support the transportation of blood. Traditional medical practices need to be rethought to align with the evolving nature of warfare. Training combat medics in advanced skills such as REBOA and ultrasound can improve patient care and increase patient transport confidence. Continuous learning and adapting to failures are essential in austere medicine. Damage control resuscitation has the potential to increase combat effectiveness in Ukraine. Chapters 00:00 Introduction to Dr John Quinn and Eirik Holmstrom 02:07 Adding Co-Authors and References 04:01 Introduction to the DCRU Course 08:09 Overview of the DCRU Curriculum 13:49 Importance of Access to Blood 16:40 Acknowledging the Defence Health Administration 18:56 Interoperability and Logistic Challenges 23:35 Rethinking Traditional Medical Practices 29:24 Training Combat Medics in Advanced Skills 38:34 Continuous Learning and Adapting to Failures 41:10 The Potential of Damage Control Resuscitation

This week, Aebhric O'Kelly talks with the faculty from Tactical Medicine North from Ukraine. The College was invited to return to Ukraine to teach the DCR-U course for the TacMedNorth faculty. Summary Tactical Medicine North in Ukraine is focused on teaching prolonged casualty care and damage control recess. They started gathering information and teaching combatants in 2022 during the full-scale invasion. Their courses range from basic to advanced levels, including AEMT courses and blood resuscitation training. The goal is to provide proper training and knowledge to combat medics and non-medics. The experience of running the advanced damage control recess course was positive, with motivated students who wanted a deeper understanding of medicine. The use of guidelines and documents was emphasised to ensure proper care. The future goal is to spread the training and continue teaching at a high level. Keywords Tactical Medicine North, Ukraine, prolonged casualty care, damage control recess, combat medics, EMT courses, blood resuscitation, guidelines, training Takeaways Tactical Medicine North focuses on teaching prolonged casualty care and damage control recess in Ukraine. They offer a range of courses, from basic to advanced levels, including AEMT courses and blood resuscitation training. The use of DHA CPGs guidelines and documents is emphasised to ensure proper care. The goal is to spread the training and continue teaching at a high level. Chapters 00:00 Introduction and Background of Tactical Medicine North 03:36 Teaching Prolonged Casualty Care 08:10 The Need for a Damage Control Recess Ukraine Course 14:20 Impact of the Course on Students' Perspective 19:46 Importance of Guidelines and Documents in Tactical Medicine 23:47 Future Plans for Tactical Medicine North 30:54 Continuing Training and Education 35:41 Conclusion and Thanks

This week, Aebhric talks with Dr Sean Keenan, one of the founders of the Prolonged Field Care Working Group. They discuss his background and the development of PFC. They talk about creating the Austere Emergency Care course, which brings the lessons of prolonged field care to the civilian environment. He emphasises the importance of providing relevant and practical training that sparks interest and fosters collaboration among healthcare professionals. The conversation covers the benefits of being a non-profit organisation, the importance of continuous learning and humility in austere environments, the role of professional organisations like SOMA in supporting special operations medics, and the value of connecting with like-minded individuals in the field. The guests advise new paramedics, SOCM medics, nurses, and doctors interested in working in austere environments. Chapters 00:00 Introduction and Background 05:44 Formation of the Prolonged Field Care Working Group 30:20 The Creation of Specialized Medical Standards 40:16 The Benefits of Being a Non-profit Organisation 42:40 The Role of Professional Organizations in Supporting Special Operations Medics 45:04 Connecting with Like-Minded Individuals in the Field 49:02 Advice for new Paramedics, SOCMs, Nurses, and Doctors in working in austere environments   Takeaways The Prolonged Field Care Working Group was formed to address the need for extended medical care in austere environments by Sean Keenan, Paul Loos and Dennis Jarema. The group developed the Austere Emergency Care course to teach civilian remote medics the lessons of prolonged field care. The course is designed to provide relevant and practical training that sparks interest and fosters collaboration among healthcare professionals. Creating the Specialized Medical Standards non-profit organisation allows for the continued support and development of the Prolonged Field Care Working Group and the Austere Emergency Care course. A non-profit organisation can open doors and create opportunities in various fields, including medical and educational institutions. Continuous learning, humility, and being a team player are essential qualities for working in austere environments. Professional organisations like SOMA provide a platform for networking, exchanging ideas, and solving operational problems in special operations medicine. Connecting with like-minded individuals in the field can lead to valuable collaborations and sharing of knowledge and experiences. New paramedics, SOCMs, nurses, and doctors should focus on being excellent medical professionals, always learning, and acting in the best interests of their patients and teams.

This week, Aebhric O'Kelly talks with Rae Richburg, who attended almost three months of CoROM short courses this Spring term. Rae talks about her work as a registered nurse in prison psychiatric wards. She discussed her experiences spending three months in Pretty Bay, Malta, taking every CPD course on the schedule.

This week, Aebhric O'Kelly talks with Bobby Litton, a paramedic and teacher, and discusses his career and aspirations in pre-hospital medicine. He shares his experiences working in Iraq and the UK and his pursuit of advanced degrees and certifications. Bobby emphasizes the importance of continuous learning and surrounding oneself with knowledgeable and skilled individuals. He advises those interested in working in austere environments, including gaining experience through volunteering and investing in education.   Keywords paramedic, pre-hospital medicine, career, aspirations, experience, advanced degrees, certifications, learning, volunteering, education   Takeaways Continuous learning and self-improvement are essential in the field of pre-hospital medicine. To enhance your skills and knowledge, surround yourself with knowledgeable and skilled individuals. Gaining experience through volunteering and participating in expeditions can be valuable for working in austere environments. Investing in education and pursuing advanced degrees and certifications can open up opportunities for career advancement. Strive to be a better medic and constantly evaluate and improve your skills and knowledge.   Sound Bites "We all love trauma. It's all the primary care stuff that is our bread and butter." "The course is shifted to the environment with training paramedics to work in a pre-hospital condition that can provide the prolonged field care treatment in resource-poor environments without a lot of help."   Chapters  00:00 Introduction and Background 02:50 Paramedic Training and Challenges 07:52 Career Path and Future Plans 11:02 Working in the UK and Hospital Challenges 14:56 Transitioning to ACP and Specializations 25:08 Importance of Education and Continuous Learning 29:03 Teaching and Mentoring in Pre-hospital Medicine 32:00 Advice for New Paramedics and Healthcare Professionals

This week, Aebhric O'Kelly talks with Yvette Nunes, a cruise ship nurse, who shares her experience working on an expedition ship and the unique challenges and opportunities it presents. She discusses the expedition's mission: to take guests to new and remote areas and provide them with close-up nature experiences. Yvette explains the day-to-day life of a nurse on board, including managing the medical centre, accompanying the expedition team on landings, and being on call 24/7. She also highlights the importance of continuous professional development and her training in Malta. Yvette shares memorable cases she has dealt with, such as managing bleeding oesophageal varices and performing blood transfusions on board. She offers advice for healthcare professionals interested in working in austere environments.   Takeaways Embarking on a career as a nurse on an expedition ship is a unique journey filled with challenges and opportunities. It's a chance to experience remote areas and provide medical care in diverse environments, a prospect that is both thrilling and inspiring. In this field, continuous professional development is not just encouraged, it's a necessity. It's a commitment to enhancing your skills and knowledge in emergency and critical care medicine, a journey that will keep you motivated and always striving for more. The medical team on board must be prepared to handle various medical conditions and emergencies, from myocardial infarctions to anaphylaxis. Having telemedicine capabilities and access to specialists is crucial when working in remote areas with limited access to definitive care. Healthcare professionals interested in working in austere environments should take advantage of online learning opportunities and seek out companies that invest in training and development.   Chapters 00:00 Introduction and Background 01:31 The Mission of the Expedition Ship 09:11 Medical Challenges and Responsibilities 13:08 Importance of Continuous Professional Development 21:24 Daily Life on an Expedition Cruise Ship 26:20 Training and Qualifications for Shipboard Medical Staff 28:25 Memorable Medical Cases 31:27 Future Plans and Career Advancement 39:02 Advice for Healthcare Professionals in Austere Environments