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

This week, Aebhric O’Kelly is joined by Rob Schembri, a Canadian critical care paramedic with Ornge, Ontario’s air ambulance service, and a student on CoROM’s MSc in Austere Critical Care.Rob discusses his journey through critical care paramedicine, his recent move onto a special operations team and why, after decades in the profession, he decided to pursue postgraduate education in austere medicine. His new role includes supporting the transport of patients with high-risk pathogens and mechanical cardiac support, as well as USAR and other specialist operations. The conversation explores the Canadian paramedic system, including the progression from Primary Care Paramedic to Advanced Care Paramedic and ultimately Critical Care Paramedic. Rob explains the extensive training required at the critical care level and how international paramedics can enter the Ontario system. Rob also talks candidly about undertaking his first research project, navigating ethics approval and discovering that the thesis he initially dreaded has become one of the most interesting parts of his MSc.The episode finishes with a discussion about lifelong learning, career development and Rob’s advice to clinicians beginning a career in austere medicine: learn as much as you can, experience as much as you can—and enjoy what you do. Chapters00:00 – Meet Rob Schembri: Critical care paramedicine, Ornge and joining the special operations team.01:18 – The Malta Connection: Rob's Maltese heritage and his family's move to Canada.03:03 – Returning to Malta for a Master's Degree: The irony of pursuing postgraduate education in the country his parents left.03:25 – Why the MSc in Austere Critical Care?: Preparing for specialist critical care and special operations.05:02 – High-Risk and Special Operations Medicine: High-risk pathogens, mechanical cardiac support, USAR and specialist transport.06:50 – Why Study Austere Critical Care in Malta?: Choosing CoROM rather than a conventional Canadian critical care programme.08:18 – POCUS and Future Training: Bringing austere prehospital ultrasound into specialist practice.11:05 – Reaching the MSc Thesis: Rob's progress through the programme.11:36 – Researching Cognitive Load in Austere Conditions: Identifying a gap in conventional critical care paramedic training.13:32 – Designing the Research: Comparing conventional scenarios with scenarios incorporating austere stressors.15:02 – From Dreading Research to Enjoying It: Becoming a first-time clinical researcher.16:01 – Research Ethics: The challenges of preparing an ethics submission.17:42 – Why an MSc Should Include Research: Thesis versus coursework and what it means to earn a Master of Science.19:42 – What Comes After the MSc?: PhDs, lifelong education and knowing when to give the family a break.20:32 – Taking a Maltese MSc Back to Canada: Recognition, professional development and teaching opportunities.22:31 – How Canadian Paramedicine Works: PCP, ACP and Critical Care Paramedic pathways.24:43 – Moving Between Canadian Provinces: Reciprocity and employment across provincial systems.25:40 – Is There a Canadian Paramedic Registry?: How Ontario regulates and identifies paramedics.26:59 – International Paramedics Coming to Ontario: Where UK, Australian, South African and other clinicians may fit.28:09 – Comparing US and Canadian Paramedic Education: Training pathways and entry into critical care practice.30:06 – Becoming a Critical Care Paramedic in Ontario: The 16–18-month training process and clinical placements.31:17 – “It's Never Too Late”: Rob became a critical care paramedic in his fifties.32:04 – What Would Rob Do Differently?: Looking back on the MSc and a 36-year career.32:54 – Advice for the Next Generation: Learn, experience, enjoy your work and value the people around you.33:53 – Coming Home to Malta: Pastizzi, cannoli and plans to finally meet in person.

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

In this episode of CoROM Conversations, Bill Vasios is joined by Dr Bob Dichiera, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University's PA programme. Bob introduces a practical approach to remote orthopaedics built around four questions: Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation?The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated pulse, motor and sensory (PMS) assessment before and after interventions. Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise.The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments.00:00 – Tuning-fork fracture diagnosis cold open00:18 – Introduction to Remote Orthopaedics01:58 – Why MSK injuries matter in remote medicine03:00 – Orthopaedic emergencies you cannot miss04:18 – Damage-control orthopaedics05:00 – Is the patient dying? Is the limb dying?06:42 – Closed tibial fractures07:40 – Diagnosing fractures with a tuning fork09:06 – Splinting and traction decisions11:31 – Compartment syndrome14:00 – Pain with passive stretch15:30 – Open fractures16:20 – Irrigation17:00 – Antibiotics for open fractures21:06 – Field splinting and improvised splints23:30 – Shoulder dislocations25:55 – Shoulder reduction techniques28:21 – Immobilisation and rehabilitation30:45 – When should remote clinicians reduce a dislocation?33:07 – PMS and neurovascular assessment34:00 – Knee dislocations35:35 – The easily missed vascular injury37:56 – Reduction, ABI and evacuation38:45 – Ankle injuries and Ottawa Ankle Rules40:20 – Why weight-bearing does not exclude fracture42:00 – Hand and wrist injuries42:43 – Pelvic fractures44:00 – Pelvic binders and avoiding repeated pelvic assessment45:30 – Haemorrhage and pelvic trauma46:00 – Pelvis versus femoral neck fracture47:30 – Ultrasound in remote orthopaedics47:50 – Should remote clinicians perform fasciotomies?48:30 – Telemedicine and remote procedural guidance49:53 – Closing

Dr Travis Kaufman is a retired US Army physician assistant whose career spans combat engineering, deep-sea diving, White House medicine and Ukraine. He discusses medical planning for presidents, humanitarian work in Tanzania and the realities of Ukrainian stabilization points. Topics include prolonged tourniquets, delayed evacuation, battlefield sepsis, trending physiology, essential nursing care and ingenious field-expedient solutions.

This week, Aebhric O'Kelly is joined by David Page, a paramedic with more than 40 years of experience spanning frontline EMS, education, accreditation and research. David directs the Prehospital Care Research Forum at UCLA and is closely involved with the International Paramedic Registry (IPR).The conversation explores the enormous variation in paramedic education and practice around the world. David discusses his work with training centres in more than 20 countries and explains why sophisticated simulation facilities are not necessarily required to deliver excellent education.Chapters00:00 – Meet David Page: 40 years of paramedicine, research and education.01:45 – Assessing EMS Education Around the World: Lessons from training centres in 23 countries.04:30 – Simulation Without the Million-Dollar Lab: Creating effective training with limited resources.05:20 – What Is the International Paramedic Registry?: Establishing international standards for paramedicine.08:01 – Learning from the US National Registry: Why independent certification matters.10:28 – Defining Levels of Paramedicine: Responder, basic and advanced practice.13:03 – What Should Every Paramedic Know?: Building and validating 1,028 international competencies.17:32 – Is IPR Becoming an International Standard?: Adoption, recognition and international mobility.19:44 – Certification vs Licensure: An important distinction for international paramedics.21:47 – Degree vs Certification: Does graduating from university prove clinical competency?26:47 – Does a Degree Guarantee Competence?: Why David argues for independent verification.28:20 – US vs UK Paramedics: Who Is Better?: Why minimum standards matter more than comparison.29:17 – When the Same Job Title Means Different Skills: Comparing paramedic education and scope internationally.30:35 – Does Programme Length Matter?: Why three years of education can mean very different things.33:40 – Australia's Nurse–Paramedic Model: Different professions and different clinical environments.36:43 – The UK Paramedic Model: Degrees, registration and the changing ambulance workforce.39:36 – Germany, Spain and European EMS: Different routes to prehospital practice.41:50 – Does France Have Paramedics?: Looking beyond professional labels.44:12 – Can Nurses Take the IPR Exam?: Why hospital expertise does not automatically equal prehospital expertise.44:52 – Paramedicine Is a Specialty: A separate environment requires a separate body of knowledge.45:25 – Research, Education and Clinical Practice: David's three-legged stool of paramedicine.46:56 – “Soak It Up, Buttercup”: David's advice for the next generation.47:38 – The Privilege of Being a Paramedic: Human dignity, patients and why the work matters.

Jason Jarvis, a former Special Forces medic and tropical medicine researcher, explores malaria care far from reliable labs or pharmacies. They cover parasite biology, prevention, chemoprophylaxis, current treatments, and the promise of investigational cabamiquine-pyronaridine as a possible single-dose option. The conversation also examines resistance, vaccines, G6PD concerns, stewardship, and diagnosing malaria in austere settings.

Christoffer Mäkitalo is a Swedish ambulance and anaesthesia nurse, combat nurse, and medical instructor. He discusses why prolonged care is routine across northern Sweden’s vast distances, and how battlefield evacuation delays are reshaping training in Ukraine. Topics include combat lifesaver education, blood resuscitation, ultrasound, helicopter decisions in Arctic conditions, and the essential nursing skills that keep casualties safe while waiting for definitive care.

Aebhric O'Kelly is joined by Dr Csaba Dioszeghy, CoROM co-founder and CEO, critical care and emergency medicine consultant, cardiologist, and experienced prehospital clinician.The conversation explores what makes education for remote and austere clinicians fundamentally different from conventional medical education. CoROM students work across the world in military, humanitarian, offshore and other resource-limited environments. Csaba discusses why education needs to adapt to these clinicians rather than expecting their professional lives to conform to a traditional university model.A major theme is listening to students. Aebhric and Csaba discuss how student feedback has directly influenced CoROM's curriculum, facilities, administration and teaching methods — including significant changes being introduced for the new academic year.They also discuss the redevelopment of the MSc in Austere Critical Care, including more interactive online learning, greater flexibility for students who cannot travel to Malta, and expanded opportunities for practical education. The discussion considers an important question for modern medical education: how much of postgraduate austere medicine can genuinely be taught online, and what still requires hands-on experience?Chapters00:00 – Welcome to Season 5A new academic year, a new podcast season and the changing face of CoROM.00:38 – CoROM's Next ChapterCsaba's role as CEO, consolidating a decade of growth and the College's ambitions for the future.03:02 – What Makes CoROM Different?Building flexible education for clinicians working across military, humanitarian, offshore and resource-limited environments.06:52 – Listening to Our StudentsHow student feedback directly influences curriculum, facilities and the way CoROM teaches.09:23 – Changing the Practical CurriculumRevamping classroom education, investing in facilities and placing greater emphasis on hands-on learning.11:34 – Rebuilding the MSc in Austere Critical CareNew modules, interactive education and moving beyond traditional recorded online lectures.13:07 – Can You Teach Austere Critical Care Online?Accessibility, international students and why the redesigned MSc can now be completed without compulsory travel to Malta.18:01 – Improving Support for Online StudentsHuman faculty support, central administration and improving communication with students.19:54 – Building a Better Student Information SystemModernising the administrative infrastructure behind a growing international College.21:02 – Building the CoROM CommunityThe future of CoROM's membership structure and strengthening the wider professional community.23:05 – The CoROM Digital LibraryBuilding offline access to field guides, publications and educational resources.25:41 – A New Digital and Physical CoROMNew content, facilities, Moodle, equipment and the systems being developed for the new academic year.28:05 – Quality Assurance and the Future of CoROMInstitutional review, reaccreditation and the longer-term direction of the College.29:33 – More Hands-On, Less PowerPointUpdating the BSc and MSc programmes and increasing practical learning when students come to Malta.32:17 – International PartnershipsGrowing educational, clinical and research relationships around the world.34:02 – Advice for the New Austere MedicWhat should a doctor, nurse or medic entering austere medicine concentrate on?35:00 – When Guidelines Don't Fit the EnvironmentWhy guidelines developed in well-resourced healthcare systems may not always translate directly into resource-limited care.36:02 – Your Brain Is Still a ResourceUnderstanding physiology, thinking beyond protocols, innovation and Csaba's final advice: be brave and don't give up.

This week, Aebhric O'Kelly is joined by Professor Mark Hannaford, founder and CEO of World Extreme Medicine, to discuss the evolution of expedition medicine, humanitarian response, and the growing importance of prolonged casualty care in modern conflict.From kayaking in Patagonia and Antarctica to developing one of the world's leading extreme medicine organisations, Professor Hannaford shares the experiences that shaped his career and explains how World Extreme Medicine has become a global leader in expedition medicine education, research and humanitarian training.About the SpeakerProfessor Mark Hannaford is the Founder and CEO of World Extreme Medicine (WEM), an organisation dedicated to advancing healthcare in remote, austere and expeditionary environments.Topics CoveredProfessor Hannaford's journey into expedition and extreme medicineThe origins and philosophy of World Extreme MedicineWhy expedition medicine is about far more than trauma careThe importance of primary care in remote environmentsDeveloping multidisciplinary expedition medical teamsBreaking down barriers between military, humanitarian and civilian medicineLessons learned from humanitarian work in UkraineTraining civilians in Stop the Bleed and emergency trauma careThe growing importance of Prolonged Casualty Care in modern warfareHow drone warfare is changing casualty evacuationCreating the MSc in Extreme Medicine at the University of ExeterWhy research is essential for advancing austere medicineAdvice for clinicians interested in expedition medicineThe importance of mastering the basics before deployingBuilding experience through events, rescue organisations and outdoor medicineThe future of extreme medicine and global medical educationChapters00:00 – Introduction Introducing Professor Mark Hannaford Correct pronunciation and welcome00:36 – Mark's background From geographer to expedition leader Living in Abu Dhabi A lifetime in expedition and remote medicine02:02 – Supporting Ukraine The origins of the World Extreme Medicine Fund Choosing a focused humanitarian mission Current work in Ukraine04:43 – Adventures in British Columbia Kayaking with orcas Patagonia expeditions Antarctica and the Arctic Wildlife and expedition life09:56 – How World Extreme Medicine began Early expedition medicine Standardising expedition medical support Paying expedition medics Building multidisciplinary teams15:04 – Breaking down medical silos Why WEM became World Extreme Medicine Bringing together military, humanitarian, wilderness and expedition medicine The evolution of the WEM Conference17:47 – Medicine beyond medicine Expedition skills Bushcraft Vehicle safety Risk management19:17 – Primary care versus trauma The reality of expedition medicine Why prevention matters20:29 – The WEM Fund in Ukraine Medical supply convoys TCCC and Stop the Bleed Training civilians Building local capability27:44 – Prolonged Casualty Care Changing battlefield realities Drone warfare Extended evacuation times Adapting PCC education to frontline needs30:03 – Sharing Ukraine's lessons Teaching civilians NATO exercises Disseminating battlefield medical lessons32:27 – Creating the MSc in Extreme Medicine Partnership with the University of Exeter Professionalising expedition medicine Research priorities Translating austere medicine into mainstream healthcare37:59 – Advice for new expedition medics Master the basics Know your limits Gain domestic experience Find mentors Say yes to opportunities40:36 – Final advice Prepare for your environment Listen more than you speak41:22 – Closing remarks Reflections on Professor Hannaford's contribution Final thoughts and thanks

Bill Vasios, a physician associate and educator in austere and remote healthcare, shares practical wisdom. He discusses using simple OTCs for traveller’s diarrhoea and rehydration. He covers symptom relief for respiratory infections, pain packs and musculoskeletal care, wound irrigation, allergy and insect‑bite management, heat illness strategies, reflux remedies, and assembling an austere OTC medical kit.