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

This week, Aebhric O’Kelly talks with Zach Andrews, a SOF medic, to discuss his journey through the MSc in Austere Critical Care, with a focus on his thesis on microcirculation in resource-limited settings. He shares insights into the challenges and learning experiences of his studies, the development of the AMSS score for assessing microcirculation, and his future aspirations in medicine, particularly in rural EMS and education.TakeawaysZach is on active duty in the U.S. Army as a SOF medic.He works as a critical care paramedic in a rural county.His thesis focused on microcirculation in resource-limited settings.He explored noninvasive methods for assessing microcirculation.Zach developed the mottling score to evaluate microcirculation.He emphasises the importance of basic medical skills.Zach plans to pursue a doctorate in the near future.He aims to validate his Microcirculatory Integrated Severity Scale (AMSS) in real-world settings.Zach believes in the significance of education in rural healthcare.He appreciates collaborative problem-solving in medical training.Chapters00:00 Introduction to Zach Andrews and His Journey06:08 Exploring the Master's Program in Osteo-Critical Care13:20 Thesis Topic: Microcirculation in Resource-Limited Environments20:24 Developing the Microcirculatory Integrated Severity Scale (AMSS)24:25 Future Plans and Advice for New Practitioners

This week, Aebhric O’Kelly, Bill Vasios, and Rhod Jordan lead an open discussion examining the critical role of nutrition in prolonged field care. The conversation explores enteral and parenteral feeding modalities, outlining their respective indications, benefits, and practical limitations in austere and resource-constrained environments. Particular emphasis is placed on the value of early nutritional intervention in supporting physiological recovery, including practical techniques for nasogastric tube placement and for identifying and managing feeding-related complications. The discussion further considers the challenges of maintaining nutritional support during patient transport. It highlights the importance of interdisciplinary collaboration, including consultation with nutrition specialists, to develop safe and effective nutritional care plans.TakeawaysNutrition is crucial in prolonged field care.Enteral nutrition is less invasive and safer.Early feeding improves healing and recovery.Consult a nutritionist for feeding plans.NG tubes can reduce complications in feeding.Monitor for complications during feeding.Parenteral nutrition may be necessary in some cases.Feeding techniques can vary based on patient condition.Understanding nutritional needs is essential for care.Future discussions will focus on advanced topics.Chapters00:00 Introduction to Prolonged Field Care and Nutrition02:40 Understanding Enteral and Parenteral Nutrition04:53 Benefits of Early Nutritional Support07:47 Indications and Contraindications for Feeding09:32 Practical Considerations for Feeding in Austere Environments11:51 Calculating Nutritional Requirements14:30 Challenges in Nutritional Support During Transport17:16 Techniques for NG Tube Placement20:00 Monitoring and Managing Feeding Complications22:19 Discussion on Parenteral Nutrition24:41 Conclusion and Future Topics

Join a riveting discussion on managing sepsis in remote care. The hosts dive into assessing septic patients with focused history and trending vitals. Learn about the importance of early warning systems like QSOFA and NEWS2. They explore the critical role of point-of-care ultrasound and monitoring techniques, including MAP and urine output. Antibiotic strategies in austere settings are highlighted, alongside malaria treatment protocols. The episode wraps up with innovative care methods like telemedicine consultations and the FLASH mnemonic for risk assessment.

Bill Vasios, an experienced clinician in austere care, and Rhod Jordan, a clinical practitioner focused on remote medicine, dive into the intricacies of burn management. They discuss critical airway management, innovative fluid resuscitation strategies, and the importance of patient involvement in care. The duo highlights methods like the use of topical morphine for pain relief and the necessity of accurate assessments to prevent infection. Their insights reveal that managing burns is as much about art as it is about science.

This is a brief introduction to the AI roundtable to be held at the Medicine in the Mediterranean conference, running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This is a brief introduction to the AI roundtable to be held at the Medicine in the Mediterranean conference, running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

This is a short introduction to the two lectures that Dr Slaven Bajic will be giving at the Medicine in the Mediterranean conference running from 31 January to 2 February. You can join us using the link below.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

Join Bill Vasios, a skilled physician associate, and Rhod Jordan, a seasoned remote paramedic, as they dive into the Practical Prolonged Casualty Care manual. They discuss the essential role of clear communication in patient care and emphasize training for non-medical responders. Rhod highlights the significance of promoting patient autonomy and recognizing nonverbal pain signals. The conversation also touches on cultural considerations and practical techniques for prolonged casualty care, making it clear that fostering teamwork can lead to better outcomes.

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at ⁠Medicine in the Mediterranean⁠, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum. Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/

Discover the voices shaping the future of remote, austere, and expeditionary healthcare. In this special podcast preview, you will hear directly from the expert presenters who will be leading sessions at ⁠Medicine in the Mediterranean⁠, held from 31 January to 2 February.This annual gathering brings together clinicians, researchers, and operational medics from across the globe, professionals delivering care in deserts, jungles, mountains, conflict zones, offshore platforms, and every environment in between.Places are still available, offering a rare opportunity to network with colleagues working at the cutting edge of remote medicine, gain insights from internationally recognised leaders, and strengthen your practice through evidence-based, real-world learning.If your goal is to elevate your capability in challenging environments, this is the forum. Excel by learning from those who set the standard.https://corom.edu.mt/medicine-in-the-mediterranean-2026/