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

This week, Aebhric O’Kelly talks with Tim Cranton, who shares his experiences as an offshore medic, detailing a challenging patient case involving dental pain and the complexities of providing care in a remote setting. He discusses the importance of proper patient management, the challenges of medication availability, and the need for improved training in offshore medical practice. Tim emphasises the significance of networking and continuous education for aspiring offshore medics, as well as the potential for developing specialised courses in dental care for medics working in remote environments.TakeawaysTim Cranton is an experienced offshore medic with a background in global health.Managing patients in remote settings requires careful observation and assessment.Antibiotic stewardship is crucial in offshore medical practice.Pain management is a key aspect of treating dental emergencies.Communication with topside medical services is essential for patient care.Remote healthcare often involves waiting for transport due to weather conditions.Continuous education and training are vital for offshore medics.Networking is important for career advancement in offshore medicine.There is a need for more specialised training in dental care for medics.Tim advocates for the development of a dedicated offshore medics course. Chapters00:00 Introduction to Offshore Medicine26:37 Challenges in Remote Healthcare35:19 Future of Offshore Medic Training

This week, Aebhric O’Kelly talks with James Brogan, a UK paramedic and lecturer at Robert Gordon University, who discusses the unique challenges and opportunities in paramedicine, particularly in rural and remote areas of Scotland. He emphasises the importance of practice-based learning, the role of paramedics in public health, and the evolution of paramedic education towards a more academic and professionalised approach. Brogan also highlights the significance of decision-making skills in austere environments and offers advice for new paramedics entering the field.TakeawaysJames Brogan is a principal lecturer of paramedicine at Robert Gordon University.The university focuses on rural and remote paramedicine education.Practice-based learning is crucial for paramedic training.Paramedics play a significant role in public health initiatives.Austere medicine requires unique skills and decision-making abilities.The evolution of paramedic education has led to a more academic approach.Professionalisation of paramedics is essential for adapting to healthcare needs.Future paramedics will need to be versatile in various environments.Decision-making is more critical than just technical skills.New paramedics should focus on evidence-based practice and holistic care.Chapters00:00 Introduction to Paramedicine in Scotland02:22 The Unique Challenges of Rural and Remote Paramedicine04:56 Practice-Based Learning and Its Importance07:54 The Role of Paramedics in Public Health10:13 Austere Medicine and Prolonged Field Care13:05 The Evolution of Paramedic Education15:32 The Professionalisation of Paramedicine18:17 The Future of Paramedicine20:55 Advice for New Paramedics23:29 Conclusion and Reflections on Paramedicine

This week, we have another presentation from the Medicine in the Mediterranean conference from January 2025. Dr Matt Moront is a pediatric surgeon who provides an in-depth exploration of pediatric trauma care, emphasising the unique anatomical and physiological differences in children compared to adults. The speaker discusses common pediatric injuries, particularly in urban settings, and highlights the importance of airway management, weight estimation for medication dosing, and recognising signs of shock. Techniques for intubation and intravenous access in children are also covered, along with concerns regarding radiation exposure in pediatric imaging. The session concludes with key takeaways for healthcare providers working with pediatric patients.TakeawaysAirway management is critical in pediatric patients.Children are not just smaller adults; they have unique anatomical differences.Most pediatric trauma cases involve motor vehicle accidents and falls.Weight estimation is crucial for medication dosing in children.Children can maintain blood pressure until a significant volume of blood is lost.Intubation in children requires specific techniques and considerations.Radiation exposure in children should be minimised due to their sensitivity.Pediatric patients often present differently than adults in shock situations.Using the right size equipment is essential for pediatric care.Clinical indicators of shock in children are often visual rather than reliant on technology.Chapters00:00 Introduction to Pediatric Trauma Care02:40 Understanding Pediatric Injuries in Urban Settings05:23 Anatomical and Physiological Differences in Children08:34 Airway Management in Pediatric Patients11:21 Weight Estimation and Medication Dosing for Children14:12 Assessing Pediatric Vital Signs and Shock Indicators16:54 Intubation Techniques and Considerations for Children20:08 Practical Tips for Pediatric Emergency Care25:55 Intubation Techniques for Pediatric Patients29:00 Medications in Pediatric Intubation33:57 IV Access in Children40:00 Radiation Considerations in Pediatric Care

This week, Aebhric O’Kelly talks with CoROM student Dmitry Vosnyak, who shares his experiences as a remote paramedic student currently completing clinical placements in Kilimanjaro, Tanzania. He discusses his background in emergency medicine, the challenges faced in chaotic environments, and the importance of practical training alongside theoretical knowledge. Dmitry reflects on a mass casualty incident he encountered, emphasising the need for effective pre-hospital care and communication. He also shares insights on how to prepare for such situations and his aspirations for further education in critical care.TakeawaysDmitry has extensive experience as a paramedic in various settings.Studying alongside practical experience enhances learning.The chaotic environment in emergency medicine requires adaptability.Mass casualty incidents highlight the need for pre-hospital care.Preparation and communication are crucial in emergencies.Dmitry emphasises the importance of hands-on training.He values the connections made with local medical teams.Continuous learning is essential for paramedics.Dmitry aims to improve his skills in critical care.He encourages new paramedics to study and gain practical experience.Chapters00:00 Introduction to Dmitry Vosnyak's Journey04:50 The Importance of Practical Training10:53 Clinical Placements and Skill Development17:35 Mass Casualty Incident Experience23:55 Reflections on Improvement and Preparation30:37 Future Aspirations in Critical Care43:03 Advice for new paramedics

Dr. Slaven Bajić, an emergency medicine expert with experience in austere settings like Mali, discusses the transformative role of ultrasound in pre-hospital care. He highlights the FAST protocol's advantages for trauma assessment, emphasizing speed, non-invasiveness, and its essential role in decision-making. Slaven also tackles limitations and practical challenges faced in the field. A gripping case study showcases how FAST identified critical injuries, underscoring ultrasound's growing importance in modern emergency medicine.

This week, Aebhric O’Kelly talks with Bryony Palmer, who shares her unique journey as a nurse who transitioned to sailing and humanitarian work. She discusses her experiences in offshore medicine, the challenges of providing medical care at sea, and her efforts to improve training and safety within the sailing community. Bryony also recounts a harrowing incident involving her husband's dislocated shoulder during a storm, highlighting the importance of preparation and adaptability in emergency situations. Throughout the discussion, she emphasises the need for better training and resources for sailors, as well as the value of thinking outside the box in medical practice.TakeawaysBryony Palmer is a nurse specialising in offshore and wilderness medicine.She aims to improve medical training in the sailing community.Bryony coordinated a humanitarian response with 65 sailing vessels after a hurricane.She emphasises the importance of preparation and training for sailors.Dealing with medical emergencies at sea requires adaptability and quick thinking.Bryony faced a challenging situation when her husband dislocated his shoulder at sea.She highlights the need for better medical resources on sailing vessels.Training for medical emergencies should include context-specific scenarios.Bryony encourages future sailors to practice solo sailing before embarking on long journeys.She believes in thinking outside the box to improve healthcare delivery.Chapters00:00 Introduction to Bryony Palmer and Her Journey02:48 Background in Nursing and Transition to Sailing06:41 Coordinating Humanitarian Aid in Disaster Response08:56 Training and Preparation for Sailing13:42 Dealing with Medical Emergencies at Sea36:59 Lessons Learned and Advice for Future Sailors

Explore the fascinating world of hyperbaric medicine and its historical roots. Dive into notable accidents, like the Apollo 1 fire and the Hanover chamber tragedy, revealing systemic failures and human factors that impact safety. Different chamber types and their purposes are discussed, alongside the critical need for training and maintenance. The conversation highlights off-label uses of hyperbaric therapy and emphasizes the importance of communication and strict adherence to safety protocols to prevent future mishaps.

This week, Aebhric O’Kelly talks with Andy Bell, Deputy Director of Paramedicine for St. John's Ambulance in Western Australia, who shares his extensive experience in paramedicine, discussing the evolution of the profession, the role of critical care paramedics, and the challenges faced in remote healthcare settings. He emphasises the importance of academic advancement in paramedicine and the need for a mindset shift towards prolonged field care in austere environments. Bell also provides insights into the future of paramedicine, highlighting the growing role of community paramedics and the integration of evidence-based practices in patient care.TakeawaysAndy Bell is originally from New Zealand and has extensive experience in paramedicine.Paramedics in Australia are now registered medical health professionals under APRA.The critical care paramedics have the most advanced scope of practice in Australia.There is a significant push for academic advancement in paramedicine.Evidence-based practice is essential for the future of paramedicine.Prolonged field care is a common practice in remote areas of Australia.Communication and coordination are crucial in managing patients in remote locations.Community paramedics are becoming increasingly important in the healthcare system.New practitioners should focus on mastering the basics of patient care.A mindset shift is necessary for effective, prolonged field care. Chapters00:00 Introduction to Andy Bell and His Background03:30 Understanding Paramedicine in Australia08:15 The Role of Critical Care Paramedics12:39 The Evolution of Paramedicine and Academia18:02 The Future of Academic Paramedicine22:42 Prolonged Field Care in Remote Areas29:10 Challenges in Patient Management in Remote Locations35:46 Advice for New Practitioners in Austere Medicine

In this episode of the CoROM Podcast, Dr. Sean Bilodeau discusses the intricacies of pre-hospital medicine, focusing on thoracostomy techniques and the challenges paramedics face in emergency medical services. Through case studies, he highlights the importance of evidence-based practices in needle decompression and the need for improved training methods for paramedics. The conversation emphasises the critical role of paramedics in saving lives and the ongoing efforts to enhance their skills and knowledge in trauma care.TakeawaysThe importance of thoracostomy in pre-hospital settings.Challenges faced by paramedics in emergency situations.Case studies illustrate the complexities of needle decompression.Evidence supports the effectiveness of pre-hospital interventions.Training methods for paramedics need to be improved.The role of paramedics is crucial in trauma care.Understanding the anatomy is essential for successful procedures.Finger thoracostomy may be more effective than needle decompression.There is a need for ongoing research in emergency medical practices.Collaboration between EMS and hospital staff is vital for patient outcomes.Chapters00:00 Introduction to Pre-Hospital Medicine01:28 Understanding Needle Thoracostomy06:04 Case Studies in Needle Decompression13:11 Evidence-Based Practice in EMS21:00 Teaching Techniques for Paramedics

This week, Aebhric O’Kelly talks with Alan O'Brien, OB, who is a paramedic from Ireland with a military background; they discuss his journey from the Irish Army to becoming a paramedic. He shares insights into the evolution of paramedic training in Ireland, the importance of academic pathways for military medics, and the significance of the NATO Special Operations Combat Medic (NSOCM) programme. The conversation also touches on the role of drones in modern combat medicine and the need for standardised medical training across NATO countries. In this conversation, OB discusses various aspects of military medical training, focusing on the NATO SOMT course, the future of the NSOCM programme, and the challenges faced in sustainment training for medics. He shares insights into the Irish Army Ranger Wing and the Nordic programme's impact on medical training. OB also outlines his aspirations for developing a master's programme in security and defence medicine and offers valuable advice for new medics entering the field.TakeawaysAlan O'Brien is a paramedic with a military background.He transitioned from the Irish Army to paramedic training.The paramedic training programme in Ireland has evolved significantly.Academic pathways are crucial for military medics post-service.The NSOCM programme standardises medical training across NATO.Drones are becoming increasingly influential in combat medicine.The gap between paramedic and advanced paramedic roles is decreasing.Military medics need academic recognition for their training.Standardised training improves interoperability among NATO forces.Understanding modern threats is essential for medical training. The NATO SOMT course is based on the Canadian SOMT program.SOMTs are support medics skilled in advanced medical techniques.NSOCM is evolving to include advanced medical skills training.Time constraints are a significant challenge for medics.Clinical placements are crucial for maintaining skills.The Irish Army Ranger Wing was established for counterterrorism.The unit is modeled on tier one special operations forces.The Nordic program enhances medical training across countries.A master's program in security and defence medicine is in development.New medics should take ownership of their skill set.Chapters00:00 Introduction to Alan O'Brien and His Background02:59 Transition from Military to Paramedic Training05:56 The Evolution of Paramedic Training in Ireland08:54 Academic Pathways for Military Medics12:03 The NSOCCM Program and Its Importance16:50 The Role of Drones in Modern Combat Medicine25:47 Understanding the NATO SOMT Course28:11 The Future of NSACM and Advanced Medical Skills32:21 Challenges in Sustainment Training for Medics34:28 Designing an Effective NSOCCM Sustainment Course41:12 Insights into the Irish Army Ranger Wing46:07 The Nordic Program and Its Impact48:20 Future Aspirations and Advancements in Medical Training52:16 Advice for New Medics and Medical Personnel