CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.
Published by College of Remote and Offshore Medicine
Business
Non-Profit
Hosted by Aebhric O'Kelly, a critical care paramedic and former Green Beret, CoROM Cast explores wilderness medicine, austere healthcare, tropical diseases, emergency medicine, and remote medical practice. Weekly discussions feature global experts on Prolonged Field Care, Austere Critical Care, disaster medicine, humanitarian response, military pre-hospital care, tropical medicine, expedition healthcare, medical innovation, and practical solutions for healthcare in resource-limited environments. Published by CoROM Press www.corom.edu.mt
This week, Aebhric O'Kelly speaks with David Stanton, a search and rescue paramedic, former Medic One paramedic, wilderness medicine educator, researcher at the University of Nottingham, and humanitarian medical instructor. David discusses why exceptional basic life support remains the foundation of all advanced medical care, explores innovations from Seattle's renowned Medic One system, shares lessons from Ukraine, and explains his research into prolonged casualty care and medical intelligence. Chapters 00:00 – Introduction and David Stanton's background 01:00 – The Seattle Medic One system explained 03:00 – Why Seattle achieves exceptional cardiac arrest survival 06:30 – Innovation, research and improving patient outcomes 08:20 – Head-up CPR and evolving resuscitation science 10:00 – Good ALS begins with great BLS 13:00 – Building confident and capable EMTs 17:00 – Should every EMT become an Advanced EMT? 20:30 – Teaching maxillofacial trauma management in Ukraine 23:00 – Learning from Ukrainian combat medicine 27:30 – Teaching wilderness medicine at Nottingham 29:20 – Medical intelligence as an intelligence discipline 32:00 – Rethinking prolonged casualty care 35:00 – Constraint as the foundation of prolonged casualty care 38:30 – NATO's Vigorous Warrior exercise 40:20 – Final advice for new austere medical providers About the Guest David Stanton is a search and rescue paramedic with nearly two decades of pre-hospital experience. His career includes service within Washington State's Medic One system, international rescue operations, humanitarian medical education, and research at the University of Nottingham. His current work focuses on prolonged casualty care, medical intelligence, wilderness medicine, and improving healthcare delivery in austere and conflict environments. Keywords Seattle Medic One, David Stanton, paramedic, EMT, Advanced EMT, CPR, cardiac arrest, BLS, ALS, wilderness medicine, austere medicine, prolonged casualty care, combat medicine, Ukraine, medical intelligence, NATO, Vigorous Warrior, TCCC, JTS, CoROM Podcast
This week, Aebhric is joined by Fred, who has spent almost four and a half years working in military and military-adjacent medicine in Ukraine, primarily on the forward line of troops (FLOT), with additional experience at casualty collection points and stabilisation points. In this episode, he and Aebhric trace how combat casualty care has changed since 2022: evacuation timelines have stretched from minutes to weeks, wounding patterns have shifted as troop formations disperse to avoid drone strikes, and medics on the ground are being asked to deliver prolonged field care (PFC) far beyond their training. The conversation covers current combat wound pack medications, the phase-out of nalbuphine, tramadol's hepatotoxicity risk in dehydrated patients, the training gap between CLS/CMC-qualified providers, and the disease and non-battle injury (DNBI) burden from leptospirosis to Lyme disease to anthrax that frontline medics are managing largely on their own. Chapters 00:00 – Introduction and guest welcome 01:00 – Four years of medical experience on the Ukrainian front 02:00 – How drone warfare has changed casualty patterns 03:10 – Evolution of TCCC and prolonged evacuation 04:20 – Changes to battlefield medications and analgesia 06:00 – Ketamine, morphine and tramadol in prolonged casualty care 08:00 – The challenge of prolonged pain management 09:15 – Nerve blocks and expanding combat medic skills 10:15 – Closing the knowledge gap for frontline medics 12:00 – Self-directed learning and educational resources 13:15 – Current medical training available in Ukraine 15:00 – Could prolonged casualty care become a formal certification? 16:00 – A day in the life of a frontline combat medic 18:15 – Drone casualty evacuation: promise and limitations 20:00 – What knowledge do combat medics really need? 22:00 – Disease, dehydration and prolonged field medicine 23:20 – Final advice for new austere medical providers Evolving battlefield medicine. Evacuation that once happened within minutes from positions near the front now can take weeks, driven by pervasive drone surveillance and strike capability. Mass casualty incidents near the front line have become less common as units disperse, changing the injury and casualty flow medics have to plan for. Training and knowledge gaps. There's a wide spread in provider background — from Ukrainian feldshers (registered-nurse equivalent) to personnel who completed a seven-day CMC course — all filling the same frontline medic role. Nerve blocks beyond digital blocks aren't commonly taught. Fred argues CMC training was never meant to stand alone; it assumes a prior EMT-level foundation that many providers don't have. Training availability is inconsistent and largely filled by NGOs of varying quality, with NAMT/CLS/CMC certification currently the closest thing to a standard. Evacuation reality on the ground. Getting to a casualty may take hours to days depending on drone "weather windows." Waits of 30–60 days for evacuation are not unheard of. As a result, stabilisation points are increasingly seeing patients who would survive regardless of intervention, rather than the critical mid-triage-category patients medics are most needed for. Ground evacuation drones (UGVs) are seeing real use but only for stable patients, since medics can't manage an airway or maintain a sedated patient during transit; aerial casualty evacuation is currently considered infeasible due to drone threats. Disease and non-battle injury (DNBI). Fred and Aebhric discuss the need for a Ukraine-specific DNBI framework and better environmental/threat updates reaching medics in the field. Closing advice. Fred's advice for new medics, nurses, and physicians entering austere medicine: keep learning and keep developing — people are counting on you to do your job well.
This week, Aebhric O’Kelly is joined by Bill Vasios and Rhod Jordan for an interactive discussion on one of the most important and often overlooked areas of remote medicine: Austere Primary Care. Whilst trauma often dominates training, the reality is that most remote clinicians spend far more time managing diarrhoeal illness, skin infections, musculoskeletal injuries, respiratory complaints, fever, environmental illnesses, and preventative healthcare. The panel discusses the clinical mindset required to work in resource-limited environments, introduces CoROM's CHART patient assessment system, and explores practical approaches to diagnosis when advanced investigations are unavailable. Whether you work in expedition medicine, offshore healthcare, humanitarian operations, military medicine, or remote primary care, this episode provides practical insights into becoming a more capable austere clinician. Chapters 00:05 – Welcome to CoROM Conversations 00:17 – Why primary care matters more than trauma in remote medicine 01:10 – Defining austere and resource-limited environments 02:00 – Developing the austere clinical mindset 02:40 – Becoming comfortable with uncertainty and limited resources 04:00 – Building confidence through deliberate practice 05:00 – Wilderness medicine and learning outside the ambulance 07:15 – Resilience and supporting expedition teams 08:00 – Common primary care presentations in austere environments 08:15 – Gastrointestinal illness, dehydration and traveller's diarrhoea 08:45 – Skin disease, wound care and blister management 09:30 – Environmental illness: hypothermia, frostbite and heat injury 10:10 – Musculoskeletal injuries in expedition medicine 11:55 – Learning orthopaedic assessment through repetition 13:00 – ENT, eye and dental emergencies 14:20 – Introducing the CoROM CHART assessment framework 16:40 – Chief Complaint, Condition and the CPRO assessment 17:20 – Recognising the critically ill patient 20:15 – History taking using SAMPLER with additional risk assessment 22:00 – Secondary assessment using the BEAST observations 26:10 – Review of systems using CRANES 27:30 – Treatment, disposition and clinical trending 28:10 – Diagnostic tools for austere medicine 30:30 – Essential point-of-care investigations 31:00 – Why every diagnostic tool needs a backup plan 33:00 – Altitude, pulse oximetry and interpreting observations 34:00 – Fever assessment in austere environments 34:45 – Measuring temperature correctly in older adults and children 35:40 – Managing fever of unknown origin and malaria 36:10 – Nursing care and prolonged patient management 36:45 – Public health and preventative medicine 37:30 – Recognising clinical red flags 38:00 – Key learning points and deployment preparation 39:00 – The importance of clinical examination over technology 40:00 – Trusting your senses and treating the patient—not the monitor 41:00 – Closing remarks and CoROM CPD opportunities Key Topics Discussed Austere primary care Clinical reasoning in resource-limited environments The austere clinical mindset Preventative medicine Travel medicine Wilderness medicine Expedition healthcare Remote diagnostics Fever of unknown origin Malaria diagnosis Environmental medicine Musculoskeletal injuries Skin disease Point-of-care ultrasound Nursing care in prolonged field care The CoROM CHART assessment system CPRO and BEAST observations Differential diagnosis Key Takeaways Most remote clinicians spend considerably more time managing primary care conditions than major trauma. Clinical confidence develops through experience, deliberate practice and mentorship. Every piece of diagnostic equipment should have a backup plan. Careful history taking remains one of the most valuable diagnostic tools available. Trend observations over time rather than relying on single measurements. In malaria-endemic regions, malaria should remain high on the differential diagnosis for every patient with fever.
In this special episode of the CoROM Podcast, Dr Winston de Mello joins Aebhric O’Kelly for a wide-ranging discussion on burns, military medicine, medical education, mentorship, and the evolution of austere healthcare. A founding influence behind CoROM and a former Commanding Officer of the UK military's Battlefield Advanced Trauma Life Support (BATLS) programme, Winston reflects on decades of service, from treating burn casualties after the Falklands War to helping shape generations of military medics, doctors, nurses, and paramedics. The conversation explores prehospital burn care, topical morphine, ketamine procedural sedation, the origins of several austere medicine assessment techniques still taught today, and the importance of lifelong learning and compassionate patient care. Chapters 00:05 – Introduction to Dr. Winston DeMello 00:53 – Current work in burn care and pelvic pain medicine 01:17 – The origins of Severe Burn Life Support (SBLS) 02:46 – Burn education at bachelor's and master's level 03:29 – How the Falklands War sparked a lifelong interest in burns 04:50 – Why severe burns remain a chronic disease 06:07 – The importance of burn education in austere medicine 06:55 – The fundamentals of burn management 07:09 – Why cling film remains one of the best burn dressings 08:02 – Infection prevention and moisture control with cling film 08:59 – Teaching burn care internationally 09:29 – The story behind topical morphine for burns 11:11 – Twenty years of experience using topical morphine 11:41 – Why morphine should be diluted with water rather than saline 12:20 – Topical morphine for ulcers, wounds, and joint pain 13:11 – What is a ketamine shower? 14:00 – Burn dressing changes under ketamine procedural sedation 15:28 – Why ketamine remains underutilised in medicine 17:27 – First meeting at the BATLS course 18:59 – Teaching catastrophic haemorrhage during wartime deployments 21:20 – The importance of passion in medical education 24:20 – The multiplier effect of teaching future instructors 25:24 – End-of-life care and battlefield medicine 26:41 – Burns education and the evolution of austere medicine 27:10 – Learning how to teach at BATLS 28:29 – The influence of legendary military instructors 30:36 – Building the BATLS faculty team 31:11 – Teaching others how to teach 32:36 – The origins of CoROM and early wilderness medicine training in Ireland 33:33 – Persistence, resilience, and building educational programmes 34:37 – Mentoring students including Grigory Tisenovich 35:14 – The origins of the "Winston Sign" for estimating CVP 38:24 – The importance of historical medical knowledge 39:18 – The "Palmar Crease Sign" and assessing anaemia 40:46 – Treating the future King of Jordan at Sandhurst 43:26 – How a military patient inspired a career in pelvic pain medicine 45:11 – Meeting Dr. Mallampati and airway management history 47:22 – The story behind the Trendelenburg name 48:29 – Reflections on mentorship and professional legacy 49:25 – Advice for the next generation of austere clinicians 50:49 – "Do the basics well, but always in style" 51:01 – Closing thoughts and future collaboration Guest Biography Dr Winston DeMello is an anaesthetist, military medical educator, burns specialist, and one of the founding influences behind the College of Remote and Offshore Medicine Foundation. He served as Commanding Officer of the UK military's BATLS programme and has held fellowships from all four Royal Colleges. His career has included extensive work in burn care, military medicine, procedural sedation, prehospital care, and pelvic pain medicine. He continues to contribute to international education through Severe Burn Life Support (SBLS) and advanced burn care training.
This week, Aebhric O’Kelly sits down with Dr Ella Corrick, Head of Postgraduate Studies at the College of Remote and Offshore Medicine (CoROM) and Director of the Doctor of Health Studies (DHS) programme. Ella discusses her work as a rural physician in the Scottish Highlands, her role in mountain rescue, and how CoROM is helping clinicians transform operational experience into meaningful doctoral research. The conversation explores rural medicine, doctoral education, research methodology, healthcare systems in austere environments, and the future of research in remote and resource-limited settings. Chapters 00:00 Introduction and welcome back to the podcast 00:25 Working as a physician in the Scottish Highlands 01:00 Life after becoming a new parent 01:40 Mountain rescue and rural emergency medicine 02:00 Joining CoROM and taking over the DHS programme 03:00 Shared challenges in rural and austere medicine 04:20 Transforming operational experience into research 06:30 Who are CoROM doctoral students? 08:30 Future directions for doctoral research 11:00 Why CoROM focuses on applied rather than laboratory research 12:30 Understanding the Doctor of Health Studies (DHS) 16:00 How long does a doctorate really take? 17:50 Oxford, Nottingham, and Ella’s research journey 22:00 Research on prescribing quality in children 25:40 How doctoral study improves clinical practice 27:40 DHS versus a traditional PhD 29:20 Advice for prospective doctoral students 32:30 Ella’s current research interests 35:00 Mountain rescue, resilience, and rural healthcare 38:00 Books, science fiction, and lifelong curiosity 40:30 Advice for clinicians entering austere medicine 41:40 Closing thoughts Topics Discussed Rural and island medicine Mountain rescue Doctoral education Research methodology Telemedicine Resource-limited healthcare Prolonged casualty care Clinical leadership Research literacy Volunteer emergency services Healthcare resilience Evidence-based medicine
This special 200th episode of the CoROM podcast celebrates four years of continuous weekly episodes and reflects on the journey of the College of Remote and Offshore Medicine. Founder Aebhric O’Kelly is joined by fellow founders John Clark and Dr Csaba Dioszeghy to discuss how CoROM began, why Malta was chosen as its home, the growth of the organisation over the past decade, and the vision for the next five years. The conversation explores CoROM’s evolution from a small training organisation into an internationally recognised higher education institution serving students from more than 30 countries across five continents. Chapters 00:00 Introduction and celebrating 200 podcast episodes 00:50 How the three founders came together 01:20 Why CoROM moved to Malta 03:40 Malta’s medical history and its connection to CoROM 08:10 Why Pretty Bay became CoROM’s home 10:20 Historical medicine in Malta and the Hospitallers 12:00 Growth of CoROM over the past three years 13:00 Launch of the Doctorate in Health Studies (DHS) 14:00 The impact of the CoROM podcast 15:00 Building a non-profit educational institution 15:50 The origins of Remote Medicine Ireland 20:00 Student growth and global reach 22:40 Medicine in the Mediterranean (MIM) Conference 26:30 The CoROM family culture 28:20 Looking ahead: the next 12 years 28:40 John Clark’s five-year vision 34:00 Dr Csaba Dioszeghy’s five-year vision 38:00 Keeping education affordable 39:00 Impact stories from Tanzania 40:20 CoROM’s mission and global influence 41:40 Reflections on 200 podcast episodes 42:30 Closing remarks Key Discussion Points Why Malta? The founders discuss the circumstances that led CoROM to Malta in 2014. What began as an opportunity to support paramedic education evolved into the establishment of a permanent educational institution. Malta’s strategic location, English-speaking environment, rich medical history, and accessibility for international students all contributed to the decision. John Clark highlights Malta’s historical identity as the “Hospital of the Mediterranean” and its longstanding connection to military and austere medicine traditions. Building CoROM Aebhric reflects on the origins of Remote Medicine Ireland and how frustration with expensive, poor-quality educational programmes motivated the creation of something different. The founders describe the progression from wilderness medicine courses to paramedic education, postgraduate programmes, and doctoral-level education. Global Reach CoROM currently serves more than 160 students from over 30 countries across five continents. The founders discuss the importance of maintaining a truly international perspective while preserving a close-knit educational culture. Medicine in the Mediterranean (MIM27) The founders discuss the rapid growth of the Medicine in the Mediterranean conference, which has become a recognised gathering point for practitioners interested in remote, austere, wilderness, expedition, military, and offshore medicine.
This month, CoROM Conversations is joined by Dr Evan Baines, Emergency Medicine Physician, EMS Fellow, former 18D, and contributor to the JTS Snake Envenomation Clinical Practice Guideline (CPG). Snake envenomation remains a major global health problem, with millions of bites occurring annually and a disproportionate burden falling on remote and resource-limited regions. In this episode, Dr Evan Baines discusses the development of the JTS Snake Envenomation CPG, practical field management, antivenom selection, operational planning, and common misconceptions surrounding snakebite treatment. Chapters 00:00 – Introduction to Snake Envenomation 01:45 – Why Snake Bites Matter in Austere Medicine 04:00 – Snakebite Myths and Immediate First Aid 05:00 – The Four Envenomation Syndromes 08:00 – Operational Planning and Antivenom Selection 11:20 – Understanding the JTS Treatment Algorithms 16:00 – Case Study: Pit Viper Envenomation 22:00 – Determining When Antivenom Has Worked 24:00 – Antivenom Dosing Principles 26:00 – Field Diagnostics and Coagulopathy Assessment 28:00 – Neurotoxic Snake Bites and Respiratory Failure 33:00 – Why Identifying the Snake Often Doesn't Matter 34:00 – Dry Bites and Return-to-Duty Decisions 36:00 – Antivenom Reactions and Anaphylaxis Management 39:00 – Tourniquets, Pressure Bandages, and Controversies 46:00 – Life Over Limb? Risk-Benefit Decision Making 51:00 – Airway Management in Neurotoxic Envenomation 55:00 – Regulatory Challenges and Deployment Considerations 57:45 – Key Take-Home Messages
This week, Aebhric O'Kelly speaks with three combat medics from Tactical Medicine North following a Tactical APUS instructor development programme in Malta. The discussion explores whether ultrasound can be taught to non-medical personnel operating in combat environments, including Combat Lifesavers (CLS) and Combat Medic Corpsmen (CMC), and how ultrasound may support prolonged casualty care, triage, and telemedicine in Ukraine. The conversation challenges traditional assumptions regarding ultrasound education, introduces the Tactical APUS concept, discusses modifications to the standard eFAST examination sequence, and reviews preliminary observations from a study comparing parasternal long-axis (PLAX) and subxiphoid cardiac views. Chapters 00:00 – Introduction 01:06 – Can Non-Medics Learn Ultrasound? 03:00 – Lessons from the APUS Course 05:30 – The Power of Home Points07:50 – What is Tactical APUS? 10:00 – Adapting eFAST for Combat Operations 12:30 – Hypothermia Prevention During Ultrasound 15:20 – The Controversial Change: Heart Last 20:00 – PLAX vs Subxiphoid Cardiac Views 24:40 – Teaching Maltese Nurses 29:10 – Should We Teach Ultrasound to Combat Lifesavers? 32:20 – Ultrasound as a Triage Tool 35:10 – Advice for Future Tactical Ultrasound Providers 38:00 – Closing Remarks Key Takeaways The parasternal long-axis cardiac viewappears easier for novice learners than the traditional subxiphoid view. Overview of the APUS and Tactical APUS training programme conducted in Malta. Discussion on teaching eFAST ultrasound to Combat Lifesavers and Combat Medic Corpsmen. Comparison with early challenges teaching combat medicine to personnel without formal medical backgrounds. Importance of simple teaching techniques and instructor adaptability. Introduction of the "Home Point" concept for each eFAST window. How home points help students recover when they become disoriented during scanning. Development of a one-day ultrasoundcurriculum for tactical providers. Focus on eFAST as a trauma tool for prolonged field care and telemedicine support. Discussion of modifying the traditional eFAST sequence. Prioritising lung assessment over cardiac views. The dangers of exposing casualties during scanning. Importance of maintaining casualty insulation and minimising gel exposure. Why the Tactical APUS team moved cardiac assessment after lung assessment. Students consistently finding the parasternal long-axis view easier to obtain. Experience using Maltese nurses as pilot students. Differences between teaching healthcare professionals and non-medical personnel. Language barriers and instructional adaptations. Moving beyond "Can we?" to "Should we?" Ultrasound as a prolonged casualty care and telemedicine tool. Supporting decision-making during extended evacuations. Using eFAST to prioritise casualties during mass casualty situations. Early identification of internal bleedingand pneumothorax. Potential role of optic nerve sheath diameter (ONSD) assessment in blast-related head injuries. Importance of accessibility of handheld ultrasound devices. The role of deliberate practice and repetition in ultrasound mastery. Reflections on the success of the Tactical APUS pilot programme. Future collaboration between CoROM and Tactical Medicine North. Final thoughts from the Ukrainian instructors. Ultrasound can be successfully taught to Combat Lifesavers and Combat Medic Corpsmen when training is focused on pattern recognition and image acquisition rather than advanced interpretation. "Home Points" provide a powerful cognitive aid for novice sonographers. Lung ultrasound may provide greater battlefield utility than cardiac ultrasound because interventions can be performed immediately. Hypothermia prevention must remainintegrated into all ultrasound training and operational use.
This week, Aebhric O’Kelly is joined by Robert Jędrych, a Polish tactical medicine instructor and founder of the Eagle Med System, who appears on the CoROM Podcast to discuss the evolution of tactical medicine and prolonged field care (PFC) training in Poland and Central Europe. Drawing from more than two decades of experience as a paramedic and tactical medicine educator, Robert shares insights into the realities of preparing civilian and military medical personnel for austere and conflict-adjacent environments. The discussion explores the growing demand for prolonged casualty care education due to the ongoing war in Ukraine, the limitations of current civilian tactical medicine pathways, and the importance of realistic scenario-based training. Robert also reflects on his first attendance at the Special Operations Medical Association Scientific Assembly conference and outlines his vision for the future of tactical medicine education in Poland. Chapters • 00:00 – Introduction to Robert Jędrych and his background in tactical and austere medicine • 02:20 – Launching the first Austere Emergency Care (AEC) programme in Poland • 03:40 – Why prolonged field care training is increasingly important in Eastern Europe • 04:40 – Medical support and casualty flow from Ukraine into Poland • 05:10 – Building Eagle Med System and tactical medicine education in Poland • 05:45 – Civilian TCCC versus TECC: the confusion in tactical medicine education • 07:30 – Why TECC lacks a Combat Medic/Corpsman equivalent pathway • 11:15 – Discussion on developing an advanced TECC training framework • 14:50 – The impact of prolonged field care and AEC training on operational readiness • 16:20 – What is missing from current tactical medicine training programmes • 17:20 – The importance of realistic scenarios, stress inoculation, and live tissue/cadaver training • 20:50 – Lessons learned from prolonged field care scenarios and provider fatigue • 21:00 – Attending the Special Operations Medical Association Scientific Assembly conference for the first time • 23:05 – Robert’s five-year plan for tactical medicine and PFC development in Poland • 25:00 – Advice for new medics entering austere and tactical medicine • 27:10 – Final thoughts and future collaboration Key Discussion Points The Growth of Austere Emergency Care in Poland Robert discusses implementing the first AEC programme in Poland and the growing recognition that prolonged casualty care requires far more than procedural medicine. Topics include leadership, communication, patient monitoring, documentation, and decision-making in hostile and resource-limited environments. Civilian Tactical Medicine and the TECC Gap The episode examines the disconnect between civilian tactical medicine needs and current educational pathways. While TCCC remains widely recognised, Robert and Aebhric discuss the absence of a TECC equivalent to the Combat Medic/Corpsman pathway and the need for advanced civilian tactical medical training. Realistic Scenario Training Robert emphasises that high-fidelity scenarios, environmental stress, fatigue, noise, and realistic casualty simulation are essential for preparing providers to function under pressure. He highlights the importance of moving beyond classroom mannequin training into operationally relevant simulation. Lessons from Ukraine Poland’s proximity to the war in Ukraine has shaped the urgency of tactical medicine education. Robert explains how exposure to real-world casualty care challenges has reinforced the need for prolonged field care training among both military and civilian healthcare providers. Building the Future of Tactical Medicine Robert outlines his vision for creating a dedicated training centre, expanding international partnerships, and building a stronger community of instructors capable of teaching evidence-based medicine grounded in operational realities.
This week, Aebhric O’Kelly is joined by Antonio from European Medics to discuss his first experience attending the Special Operations Medical Association Symposium, the growing importance of Medical Support to Irregular Warfare (MSIW), and how civilian and military healthcare systems must integrate to prepare for future conflicts and disasters. Antonio reflects on lessons from occupied Poland, resistance medicine, Ukrainian battlefield realities, and the importance of resilience, logistics, telemedicine, and improvised medicine in modern austere healthcare systems. Chapters 00:00 Introduction and Antonio’s background 01:10 First experience attending SOMA 03:10 “People over products” in tactical medicine 04:30 Civilian involvement in special operations medicine 06:50 Key lessons from the MSIW track 09:45 What is Medical Support to Irregular Warfare (MSIW)? 11:10 Historical resistance medicine in Poland and the Baltics 15:00 Underground clinics and covert evacuation chains 17:30 Telemedicine in resistance healthcare 18:30 How civilian medics can prepare for MSIW 21:00 TCCC, JTS CPGs, and tactical medicine education 22:00 European Medics Tactical Clinical Operations (TCO) course 23:30 Taiwan, resilience, and whole-of-society defence 26:20 Logistics and manufacturing challenges in conflict 28:40 Relationship building and NATO interoperability 29:10 3D printing and improvised medicine 31:20 Antonio’s passion for guerrilla medicine 34:00 Future plans: anaesthesia, ICU, and flight medicine 35:10 Advice for new medics entering austere medicine 37:00 Closing remarks Episode Highlights First impressions from the SOMA Symposium Why “people over products” matters in tactical medicine Civilian-military integration in modern conflict What MSIW (Medical Support to Irregular Warfare) actually means Historical resistance medicine in Poland and the Baltics Lessons from Ukraine and occupied territories Underground clinics and covert casualty evacuation Telemedicine and distributed healthcare networks Why civilian clinicians should learn TCCC Logistics, supply chains, and local manufacturing during war 3D printing and improvised medical equipment The future of European resilience medicine Advice for new medics entering austere medicine
This week, Dr John Quinn joins Aebhric O’Kelly to discuss the emerging field of Damage Control Procedures (DCP) for austere, prolonged, and contested environments. Dr Quinn explores the growing operational gap between Tactical Combat Casualty Care (TCCC) and definitive surgical care, particularly in Ukraine and other high-threat environments where evacuation delays can extend for days. The discussion covers the development of DCP curricula, governance challenges, telemedicine oversight, surgical skills for non-surgeons, and the operational realities driving innovation in prolonged casualty care. The episode also examines lessons learned from Ukraine, the future of austere procedural medicine, and how modern conflict is reshaping medical doctrine across NATO and partner nations. Chapters 00:05 – Introduction to Dr John Quinn and current operational work00:39 – Volunteering in Ukraine and advancing damage control resuscitation01:20 – What are Damage Control Procedures (DCP)?02:01 – The gap between TCCC and definitive surgery03:25 – Why delayed evacuation changes medical doctrine04:29 – Surgical skills for paramedics, nurses, and combat medics05:20 – Governance and legal challenges surrounding DCP06:26 – How surgeons may react to DCP concepts07:16 – Telemedicine oversight and surgeon mentorship in austere care09:11 – Surgical expertise shaping the DCP curriculum10:08 – Overview of the DCP programme structure11:16 – Tier 1 skills: surgical airways, thoracostomy, tourniquet conversion, traumatic amputations12:43 – Tier 2 skills: laparotomy, external fixation, fasciotomy, advanced burns14:29 – Tier 3 concepts: burr holes and REBOA15:47 – Future concepts: haemofiltration and advanced austere ICU care18:22 – Why DCP sounds controversial — and why it may still be necessary19:16 – Telemedicine vs autonomous procedural decision-making22:05 – Clinical governance and parallels with paramedic evolution23:38 – Why basic life support remains foundational25:35 – Historical parallels with early paramedic medicine26:36 – Expansion of chest tube and intraosseous use in Ukraine30:11 – What happens next for the DCP pathway?31:24 – The importance of listening to Ukrainian clinicians32:21 – DCP beyond special operations medicine33:32 – Introduction to the Disaster Health Institute (DHI)35:37 – Bridging strategic and operational medicine36:17 – SOF Combat Medical Conference (CMC) discussion38:19 – Upcoming RCSEd webinar on DCP39:30 – Lessons learned from Ukrainian workshops and role-zero care41:40 – Drone warfare, attacks on medical personnel, and evacuation challenges43:18 – Why Ukrainian medics are requesting Tier 1 and Tier 2 DCP capability45:18 – Upcoming DCP workshop at Medicine in the Mediterranean46:31 – Advice for clinicians entering austere medicine50:27 – AI, education, digital twins, and the future of medical content Guest bio Dr John Quinn is an operational clinician, researcher, and educator working across prehospital care, austere medicine, disaster health, and military medicine. Originally trained as a paramedic, he later completed both medical and doctoral training and now works clinically within the United Kingdom while supporting medical projects and training initiatives in Ukraine. Dr. Quinn is involved in the development of Damage Control Procedures curricula and collaborates with international subject matter experts, surgeons, and operational clinicians to improve prolonged casualty care capability in contested environments. Disaster Health Institute is a collaborative network focused on disaster health, operational medicine, epidemiology, humanitarian response, and strategic healthcare preparedness. The organisation works with subject matter experts across Europe, North America, Central Asia, Africa, and South America to develop evidence-informed approaches to modern operational health challenges.
This week, Aebhric O'Kelly is joined by William Krupa, who recently graduated from the MSc Austere Critical Care programme. They discuss wilderness medicine, tactical medicine education, prolonged field care, and his experience completing the MSc in Austere Critical Care at the College of Remote and Offshore Medicine Foundation. William shares his journey from infantry soldier to paramedic educator, discusses teaching Wilderness First Responder (WFR) programmes, reflects on attending the Medicine in the Mediterranean Conference in Malta, and provides an overview of his MSc thesis on austere mechanical ventilation using portable oxygen concentrators and closed-circuit systems. This episode explores how austere medicine education can reinvigorate clinicians, improve critical thinking, and bridge the gap between theory and operational practice. Chapters 00:00 – Introduction to the episode and guest welcome 00:41 – William’s current work in paramedicine, wilderness medicine, and tactical medicine education 01:20 – Military background and transition into medicine 02:30 – Repeating EMT training after military service 03:53 – Why repeated teaching improves clinicians and educators 05:07 – The value of teaching Wilderness First Responder (WFR) courses 07:22 – Deep dives into improvised medicine during longer wilderness courses 07:55 – The history of CoROM and how WFR led to degree programmes 09:33 – William’s first trip to Malta for APUS and ICARE 10:20 – Scenario-based learning and hands-on education at CoROM 11:34 – The realism of the ICARE moulage and burn simulations 14:05 – Medicine in the Mediterranean Conference experience 14:51 – Ukraine battlefield medicine workshop and WPC certification 15:40 – Graduation and earning the MSc in Austere Critical Care 16:14 – Publishing research and future doctoral plans 17:18 – Why William chose the MSc in Austere Critical Care 19:23 – What makes CoROM different from other critical care programmes 22:16 – Mentorship from MD-PhD faculty and practical education 26:08 – William’s MSc thesis on austere mechanical ventilation 27:39 – Using oxygen concentrators and closed-circuit systems in austere care 29:28 – Research discussion: dual oxygen concentrators and FiO₂ optimisation 31:15 – Challenges during the MSc programme 33:32 – How the MSc changed William’s clinical practice 34:44 – Suggestions for future development of the MSc programme 36:47 – Teaching WFR in Utah with Black Swan and Human Path 39:01 – Achieving Fellowship of the Academy of Wilderness Medicine (FAWM) 41:08 – Why wilderness fellowships carry professional value 43:46 – Advice for new medics entering austere medicine 45:11 – Closing remarks and congratulations Key Topics • Wilderness medicine education • WMS FAWM • Tactical medicine and TC3 instruction • Prolonged Field Care (PFC) • Austere Critical Care education • Scenario-based simulation training • Improvised medicine • Mechanical ventilation in austere environments • Oxygen conservation strategies • Wilderness medicine fellowships • Medical education mentorship • International austere medicine collaboration Key Takeaways • Scenario-based education improves retention and operational performance. • Wilderness medicine often reignites clinicians’ passion for medicine. • Austere medicine requires adaptability rather than dependence on resources. • International collaboration broadens clinical understanding and perspective. • Practical mentorship from operational clinicians is critical in advanced education. • Mechanical ventilation in austere environments may be feasible with low-resource systems. • Long-form wilderness courses allow deeper exploration of improvised medicine concepts. • Continuous learning is essential for clinicians operating in remote and austere environments.
This week, Aebhric is again joined by Zach Andrews, who leads the latest episode of CoROM Conversations, which explores the recognition and management of severe malaria in resource-limited and austere environments. Drawing on field-relevant clinical reasoning, the discussion focuses on the progression from uncomplicated to life-threatening disease, with emphasis on Plasmodium falciparum as the primary driver of severe pathology. The conversation highlights the diagnostic challenges faced by remote medics, where laboratory confirmation may be delayed or unavailable, and underscores the importance of clinical pattern recognition, early intervention, and ongoing reassessment. Particular attention is given to complications such as cerebral malaria, severe anaemia, metabolic acidosis, and hypoglycaemia—all of which significantly increase mortality if not rapidly addressed. From a prolonged field care perspective, the episode integrates pragmatic strategies for stabilisation, monitoring, and evacuation decision-making. It reinforces the need for structured patient assessment using frameworks such as CABCDEFGH, along with trending vital signs over time. The discussion ultimately bridges tropical medicine with austere critical care, offering actionable insights for medics operating far from definitive care. Key Learning Points Severe malaria is a time-critical diagnosis, most commonly associated with Plasmodium falciparum, requiring immediate treatment even before confirmatory testing. Red flag features include altered mental status, respiratory distress, severe anaemia, hypoglycaemia, and shock. Hypoglycaemia is both a complication of malaria and a side effect of treatment (e.g., quinine), necessitating frequent glucose monitoring. In austere environments, clinical diagnosis often precedes laboratory confirmation, requiring high suspicion in febrile patients with travel or endemic exposure. Fluid management must be cautious, balancing the risks of hypovolaemia and pulmonary oedema. Prolonged care requires integration of nursing principles (HITMAN, SHEEP VOMIT) to prevent secondary deterioration. Early administration of parenteral antimalarials (e.g., artesunate where available) is critical to survival. Evacuation planning should be initiated early, but delays must not postpone life-saving interventions. Timestamps 00:00 – Introduction Overview of the case and relevance to austere medicine 02:30 – Pathophysiology of Severe Malaria Mechanisms of microvascular obstruction and organ dysfunction 06:00 – Clinical Presentation Recognising early vs severe disease in the field 10:30 – Assessment Frameworks Applying structured approaches (CABCDEFGH, CPRO, BEAST) 15:00 – Management Priorities Antimalarials, glucose, fluids, and airway considerations 20:30 – Complications and Monitoring Cerebral malaria, acidosis, anaemia, and respiratory failure 25:00 – Prolonged Field Care Considerations Nursing care, documentation, and trending 30:00 – Evacuation and Decision-Making When and how to move the patient 33:00 – Key Takeaways and Closing Thoughts Clinical Pearls / Take-Home Messages Treat first, confirm later: In suspected severe malaria, delays in treatment increase mortality. Check glucose early and often: Hypoglycaemia can be rapidly fatal and easily missed. Think beyond fever: Altered mental status or respiratory changes may be the first sign of severe disease. Your greatest tool is reassessment: Trends in vital signs are more valuable than single data points. Good nursing care saves lives: Positioning, hydration, hygiene, and monitoring are critical in prolonged care environments. Suggested References World Health Organization. Guidelines for the Treatment of Malaria (latest edition). Joint Trauma System Clinical Practice Guidelines: Prolonged Casualty Care. World Health Organization. Severe Malaria (Tropical Medicine reference standards). White NJ et al. Malaria. The Lancet.
This week, Aebhric O’Kelly is again joined by Zach Andrews, a MSc Austere Critical Care graduate and expert in jungle medicine, who shares his extensive experience in remote critical care, setting up ICUs in challenging environments, and improving medical education. Discover practical tips for medical professionals working in remote areas and learn about innovative approaches to medical training and patient care. Chapters 00:00 Introduction and Guest Introduction 00:26 Zach Andrews' Background and Current Projects 01:06 Role in Student Success Department 02:34 Student Program Feedback and Challenges 05:50 Faculty and Program Cost-Effectiveness 11:27 Setting Up ICUs in Remote and Austere Areas 20:42 Importance of Hands-On Assessment in Remote Settings 23:00 The Jack of All Trades in Jungle ICU Setup 25:18 Lessons from Masters of Austere Care 27:33 SOMA Scholarship and Zach's Presentation 29:34 Advice for New Medics in Austere Medicine 30:52 Closing Remarks and Final Thoughts
This week, Aebhric talks with Alfredo Leal, who shares his extensive experience in emergency medical services, including his work with the WHO, offshore rescue missions, and medical training courses like AMLS and PHTLS. Discover valuable insights on pre-hospital care, medical assessment, and the future of emergency medicine training. Chapters 00:00 Introduction to Alfredo Leal's Journey 01:48 Experiences with the World Health Organisation 04:10 Deployment in Ukraine and Its Challenges 04:59 Advanced Medical Life Support Course Insights 07:43 The Importance of Medical Training 12:01 Differential Diagnosis in Pre-Hospital Care 16:11 Dynamic Patient Assessment Techniques 19:26 Teaching and Training in Emergency Medical Services 23:52 Future of Emergency Medical Training 27:48 Advice for New Medics in Austere Environments
This week, Aebhric O’Kelly is joined by Dr Michael Klopper, who recently earned his doctorate from CoROM and shares his journey from South Africa to becoming a doctoral candidate in AI, his extensive experience in remote medicine and mountain rescue, and his views on the future of AI in medical research and education. Discover insights on mountain medicine training, AI's role in healthcare, and practical advice for medical professionals in challenging environments. Chapters 00:00 Introduction and Dr Klopper's background 01:42 Early connection with the College and initial projects 04:06 Setting up clinical placements and courses in South Africa 05:44 East London clinical work and EMS programs 07:28 Dr Klopper's Wilderness Medicine Fellow (FAWM) and future plans 11:48 Dr Klopper's PhD thesis on AI in medicine 18:19 The importance of search mechanisms and AI in research 21:57 Risks and best practices for AI in academic research 24:57 Advice for new medical professionals and outdoor enthusiasts 28:48 Preparing for deployment in challenging environments 29:30 The role of aviation safety and small details in rescue missions 32:16 Closing remarks and future plans for Dr Klopper
This week, Aebhric O'Kelly is joined by Dr Aris Exadaktylos and Dr Susie DiMartini to discuss the critical need for specialised maritime medicine training. They explore the creation of the International Maritime Ships Doctors course, the unique challenges of offshore medical care, and the future of remote healthcare technology. They are the founding faculty for the new Faculty of Offshore and Maritime Medicine from CoROM. Chapters 00:00 Introduction to Maritime Medicine Faculty 02:14 Personal Journeys in Maritime Medicine 05:02 The Need for Maritime Medical Training 10:11 The Role and Responsibilities of Ship Doctors 16:51 Innovations in Maritime Medical Care 25:49 The International Maritime Ship Doctors Course 29:03 Future of Maritime Medicine Education
This week, Aebhric O’Kelly is joined by Rhod Jordan and Bill Vasios as they discuss how to create an ICU in the jungle. They discuss setting up and managing a remote ICU in jungle environments, focusing on site selection, equipment, logistics, and medical considerations for field medics and responders. Chapters 00:00 Introduction and Content Overview 00:41 Premise and Scenario Setup for Jungle ICU 01:33 Site Selection Criteria in Jungle Environments 02:19 Environmental Challenges: Rain, Creepy Crawlies, and Hypothermia 03:08 Privacy, Lighting, and Visibility in Remote Settings 03:53 Creating a Functional Jungle Clinic Layout 04:34 Lighting and Visibility Strategies at Night 05:31 Accessibility and Zone Planning in Field Clinics 06:09 Assessing Capacity: Multiple Patients and Beds 07:01 Monitoring Equipment: Minimum and Advanced Options 08:04 Power, Water, and Communication Logistics 08:42 Prolonged Casualty Care and Exfil Planning 09:59 Medical Supplies: Drugs, Medications, and Sterility 10:42 Camp Craft and Bushcraft Skills for Remote Medics 11:35 Wildcrafted Plants and Improvised Medicine 12:12 Communication Strategies in Dense Canopy Environments 13:08 Team Coordination and Role Assignments 14:08 Dealing with Critical Patients and Exfil Decisions 14:57 Infection Control and Hygiene in the Field 15:54 Personal and Team Safety Measures 16:39 Additional Non-Medical Gear for Remote Operations 17:16 Lighting Solutions and Bug Management at Night 18:08 Medications and Drugs for Jungle Medicine 18:45 Over-the-Counter and Emergency Medications 19:34 Special Considerations for Malaria and Vector-borne Diseases 20:04 Infection Control and Hygiene Protocols 20:56 Water Purification and Boiling Techniques 21:35 Field Sterilisation and Maintaining Sterility 22:25 Managing Glove Supplies and Hand Hygiene 23:00 Dermatology and Common Skin Conditions 23:38 Malaria Prophylaxis and Treatment Strategies 24:32 Infection Control and Personal Hygiene 25:14 Power and Charging Solutions in Remote Areas 26:04 Water Supply and Filtration Methods 26:45 Field Sterilisation and Water Boiling Techniques 27:21 Camp Craft and Bushcraft Skills for Field Survival 27:56 Wildcrafting and Medicinal Plants in the Jungle 28:47 Communication Equipment and Strategies in Dense Canopy 29:41 Team Coordination and Medical Decision-Making 30:17 Water Safety and Potable Water Management 31:05 Team Safety and Preventing Illness in the Field 32:04 Bushcraft Skills for Remote Medical Operations 32:58 Survival Skills and Improvised Medicine 33:48 Communication Tools and Emergency Signalling 34:28 Exfil Planning and Evacuation Protocols 35:14 Prolonged Casualty Care and Equipment Needs 36:01 Medical Kits and Supplies for Extended Operations 36:51 Decision-Making in Critical Situations 37:23 Non-Medical Essentials: Woobies, Tools, and Comfort Items 38:10 Maintaining Morale and Team Cohesion 38:42 Summary and Final Tips for Jungle ICU Setup
This week, Aebhric O'Kelly talks with Eirik Holmstrom about the newly updated MIC MEC and Pharm CPD courses, which have been combined into a new online CPD programme called 'Austere Primary Care.' This APC is a package that includes Disease and Non-Battle Injuries (DNBI) encountered on expeditions, in military operations, at remote clinical sites, and in resource-limited environments. You can find up-to-date information on our course webpage https://corom.moodlecloud.com/
This week, Aebhric O’Kelly talks with Dr Csaba Dioszeghy about the redesign and upgrade of the MSc Austere Critical Care programme. Every 5 years, the degree programmes undergo reaccreditation. The College has decided to double the programme's size following feedback from graduates. Chapters 00:00 Introduction to the New Masters of Austere Critical Care Program 01:03 The Complete Rehaul of the Curriculum 01:57 Flexibility and Pathways in the New Program 02:51 Comparison with UK Advanced Practice Programs 03:46 Four Pillars of the New Curriculum 04:41 Special Focus: Medical Support to Resistance Healthcare 07:02 Innovations in Improvised Medicine 08:21 Practical Modules: Ultrasound and Tropical Medicine 09:44 Student Research and Thesis Projects 11:30 Program Launch and Future Outlook
Ranking source
Apple Podcasts rankings supplied by Mato Topic Intelligence Platform.
Observed July 31, 2026.
Apple and Apple Podcasts are trademarks of Apple Inc., registered in the U.S. and other countries.
