CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine. 177-Microcirculation in PFC with Zach Andrews
Jan 9, 2026
Zach Andrews, an active-duty U.S. Army SOF medic and rural critical care paramedic, shares his journey through an MSc in Austere Critical Care. He dives into his research on microcirculation in resource-limited settings, detailing the development of the Andrews Microcirculatory Severity Scale (AMSS). Zach emphasizes the importance of noninvasive methods for assessing microcirculation and discusses his ambitions to validate AMSS in real-world scenarios while promoting education in rural healthcare. His insights on collaborative problem-solving in austere environments are both inspiring and practical.
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Dual Role: Army Medic And Rural CCP
- Zach Andrews works active duty as a U.S. Army medic while also serving as a critical care paramedic in rural Texas. He enjoys long transports and treats his rural EMS role as a rewarding 'hobby' alongside military duties.
Helicopter Not Always Faster
- Rural HEMS response can be slower and resource-limited so ground ambulances sometimes outperform helicopters on certain missions. Zach recalls a multivehicle collision where ground transport beat the helicopter back to hospital by minutes.
Microcirculation Matters Beyond Macro Signs
- Microcirculation is where nutrient and oxygen exchange actually happens, and hospital macro parameters can miss early dysfunction. Many bedside microcirculatory tools exist but are expensive and confined to research centres.