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

This week, we have another Medicine in the Mediterranean Conference speaker from January 2025. Our Vice Dean Eric Bauer talks about the PHACTORS mnemonic for managing patients in the post-intubation phase, emphasising the importance of understanding and addressing post-intubation hypotension, the role of positive pressure ventilation, and the need for ongoing resuscitation efforts. The discussion highlights various factors that can impact patient outcomes, including the transfer phase and the importance of proactive care in emergency medical settings.TakeawaysPost-intubation hypotension remains a significant challenge.The 'Platinum 10' refers to the critical 10 minutes post-intubation.Positive pressure ventilation can negatively impact haemodynamics.Hypoxia must be evaluated continuously after intubation.The transfer phase is often overlooked but crucial for patient care.Ongoing resuscitation is essential and should not stop after intubation.Good BLS and ALS care can significantly improve outcomes.Understanding the patient's history is vital for effective management.Proactive airway management leads to better patient outcomes.Continuous education on ventilation techniques is necessary.Chapters00:00 Introduction to Post-Intubation Management01:14 Understanding Post-Intubation Hypotension03:49 Factors Affecting Post-Intubation Outcomes10:10 The Role of Positive Pressure Ventilation14:19 Evaluating Hypoxia and Its Causes19:15 The Importance of Transfer Phase23:09 Ongoing Resuscitation and Pharmacology28:57 Final Thoughts on Post-Intubation Care

This week, Aebhric O’Kelly talks with Dr Matias Nocetto, the Vice President of Divers Alert Network (DAN), who shares his journey from Argentina to becoming a key figure in diving medicine. He discusses DAN's unique operations, the importance of understanding diving-related medical issues, and the challenges faced in diagnosing and treating divers. Dr. Nocetto emphasises the significance of training in diving medicine and offers advice for new medical professionals looking to enter this field.TakeawaysDr. Nochetto's journey reflects a lifelong passion for diving and medicine.DAN serves as a global resource for divers experiencing medical issues.The hotline operates 24/7, providing critical support to divers worldwide.Understanding the symptoms and history is crucial for diagnosing diving-related conditions.Decompression sickness is often misunderstood; cardiac events are a significant risk.In-water recompression is a controversial practice with many risks.Training opportunities in diving medicine are available for various medical professionals.DAN offers CME courses for those interested in diving medicine.Collaboration and support from the diving community are vital for DAN's mission.Following one's passion can lead to unexpected and fulfilling career paths.Chapters00:00 Introduction to Dr. Matias Nochetto and DAN02:52 The Journey into Diving and Medicine10:55 Day-to-Day Operations at DAN19:47 Understanding Diving Medicine and Decompression Sickness30:08 In-Water Recompression: Risks and Considerations36:15 Training Opportunities in Diving Medicine41:59 Advice for New Medical Professionals in Diving Medicine

This week, Aebhric O'Kelly speaks with Jason Jarvis, a former Special Forces medic and current PhD student, about his experiences in military medicine, the evolution of prolonged field care, and the development of the 'SHEEP VOMIT' mnemonic for patient care in austere environments. They discuss the importance of nursing care, the practical applications of medical knowledge in the field, and the challenges medical practitioners face in remote settings. This conversation delves into critical aspects of patient care, particularly in prolonged field care settings. It emphasises the importance of managing pressure points, understanding vital signs, monitoring core temperature, maintaining oral hygiene, preventing DVT, and ensuring proper input and output monitoring. The discussion also highlights the significance of turning, coughing, and deep breathing for patient recovery, culminating in the legacy of the 'sheep vomit' concept in medical training.TakeawaysJason Jarvis has a master's in infectious disease and is pursuing a PhD.Military experiences shaped his interest in tropical medicine.Prolonged field care is a systematic approach to patient care in remote settings.The 'SHEEP VOMIT' mnemonic was developed to aid in prolonged field care.Skin protection is crucial in austere environments.Hypothermia prevention is a key focus in field care.Patient mobility and exercises are essential for recovery.Checklists help ensure comprehensive patient care.The evolution of medical mnemonics reflects advancements in field medicine. Pressure sores develop in specific areas when supine.Vital signs must be documented and trended over time.Core temperature is crucial for assessing trauma patients.Oral hygiene prevents infections that can lead to pneumonia.DVT prevention is essential for immobilised patients.Urine output is a key indicator of hydration and health.Turning and coughing help maintain lung function.The 'SHEEP VOMIT' concept aids in prolonged field care training.Training should prepare providers for practical challenges.Community impact is a goal of medical training.Chapters00:00 Introduction to Jason Jarvis 00:46 Jason Jarvis: Background and Current Work02:37 Military Experiences and Deployments05:58 Transitioning to Civilian Life and DMI09:52 Prolonged Field Care: Concepts and Evolution13:45 Developing the Sheep Vomit Mnemonic18:35 Understanding the Sheep Vomit Mnemonic21:58 Practical Applications of Prolonged Field Care26:12 Exercises and Patient Mobility29:35 Managing Pressure Points in Patient Care30:05 Understanding Vital Signs and Their Importance31:10 The Role of Core Temperature in Patient Assessment32:40 Oral Hygiene and Its Clinical Significance36:02 Preventing Deep Vein Thrombosis (DVT) in Immobilised Patients40:44 Monitoring Input and Output: A Vital Sign49:04 The Importance of Turning, Coughing, and Deep Breathing55:00 The Legacy of Sheep Vomit in Medical Training

This week, Aebhric O’Kelly talks with Professor Enrico Brunetti about his extensive experience with ultrasound in infectious diseases and tropical medicine. He shares insights into the evolution of ultrasound technology, its applications in clinical practice, and the importance of education in this field. The discussion also covers the short course he developed at the University of Pavia, the challenges faced in tropical medicine, and advice for new medics interested in ultrasound.TakeawaysUltrasound has been a clinical tool since the 1980s.There are continuous advancements in ultrasound applications.Training is crucial for effective ultrasound use.The short course aims to broaden understanding of ultrasound in tropical medicine.Postgraduate certification is available for online courses.Ultrasound can diagnose and treat various tropical diseases.Networking and collaboration are key in medical education.Challenges in tropical medicine require innovative solutions.Patience is essential for mastering ultrasound skills.The global movement for ultrasound in emergency medicine is growing.Chapters00:00 Introduction to Professor Enrico Brunetti05:02 The Evolution of Ultrasound in Clinical Practice10:04 Ultrasound Applications in Infectious Diseases15:03 The Short Course in Ultrasound and Tropical Medicine from Pavia19:48 Postgraduate Certification and Online Learning24:52 Challenges and Opportunities in Tropical Medicine29:49 Advice for New Medics in Ultrasound Practice

This week, we have another MiM25 presentation from Dr John Quinn discussing Damage Control Resuscitation in large-scale combat operations, particularly in Ukraine. He shares insights from his extensive experience in emergency medicine and highlights the unique challenges faced in combat medicine, including medical logistics, terminology, and telemedicine. Dr. Quinn emphasises the importance of training, clinical governance, and the need for effective blood supply management in austere environments. The conversation also touches on the evolving practices in casualty care and the impact of modern warfare on medical operations.TakeawaysUkraine has surpassed NATO in counterinsurgency experience.Effective medical planning is crucial for combat operations.Telemedicine enhances clinical decision-making in remote areas.Logistical challenges significantly impact casualty evacuation.Understanding the terminology is essential for interoperability.Innovations like RBOA are being utilised in combat medicine.Training and capacity building are vital for partner forces.Blood supply issues are critical in combat settings.Tourniquet management is a significant concern in Ukraine.Plasma is being used due to a lack of blood supply.Chapters00:00 Introduction to the CoROM Podcast00:45 Dr. John Quinn's Background and Experience02:13 Key Assumptions in Damage Control Resuscitation03:42 Medical Planning in Large-Scale Combat Operations05:11 Challenges in Medical Logistics and Command07:35 Understanding Terminology and Echelons of Care09:58 Tactical Combat Casualty Care and Innovations11:52 Telemedicine's Role in Combat Medicine13:47 Challenges in Casualty Evacuation15:40 Logistical Challenges in Blood Supply17:34 Wounding Patterns and Weapon Systems19:50 Medical Evacuation in Challenging Environments22:35 Training and Capacity Building in Ukraine24:59 Clinical Governance and Standards in Ukraine27:39 Transfusion Practices and Challenges30:54 Addressing Tourniquet Issues and Training33:39 Plasma Use and Blood Supply Challenges36:51 Conclusion and Future Directions

This week, Aebhric OKelly talks with Leandra Lynn, a combat medic and Divers Alert Network (DAN) professional, who shares her experiences and insights into the world of diving medicine. She discusses her journey from being a linguist to a combat medic, the critical role of DAN in dive safety, and the challenges faced in handling emergency calls related to diving injuries. Leandra emphasises the importance of proper medical guidance for divers, the varying standards of diving medicine across the globe, and the benefits of DAN membership for divers. She also advises new medics entering the field of diving medicine, highlighting the significance of utilising available resources and seeking expert guidance.TakeawaysLeandra Lynn is a combat medic and works with DAN.DAN provides a 24-hour emergency hotline for divers.Diving procedures vary by region due to different medical standards.Barotrauma is the most common diving injury reported to DAN.DAN membership offers benefits like medical evacuation and insurance.Divers should consult dive medicine specialists for complex medical histories.Learning to dive in challenging conditions prepares divers for emergencies.DAN assists with global non-emergency dive safety questions.Effective communication is crucial in handling diving emergencies.New medics should leverage resources and ask questions for better outcomes.Chapters00:00 Introduction to Leandra Lynn and Her Work03:01 Diving into the Role of a Combat Medic05:51 Understanding Divers Alert Network (DAN)09:02 Challenges in Diving Medicine Calls12:02 Diving Procedures and Medical Standards Worldwide14:57 The Importance of DAN Membership17:50 Common Diving Emergencies and Injuries20:46 Resources for Diving Medicine24:01 Advice for New Medics in Diving Medicine

This week, we have another MiM25 presentation. Dr Trevor Abela discusses the unique role of nurses in Malta's emergency services, the historical context of nursing in the region, and the importance of holistic care and building trust in nursing practice. Dr Abela emphasises the need for nurses to focus on the patient as a person rather than just a set of medical needs and highlights the significance of context in providing effective care.TakeawaysMalta has a unique nurse-led ambulance service.Historical context is crucial for understanding current nursing practices.Nurses should focus on the person, not just on medical tasks.Building trust with patients is essential for effective care.Holistic care includes addressing social and psychological factors.Emergency care must go beyond basic medical priorities.Nursing education should emphasise patient-centred care.The relationship between nurse and patient impacts treatment outcomes.Nurses play a vital role in community health beyond hospitals.Clinical outcomes do not solely define success in nursing.Chapters00:00 Introduction to the Quorum Podcast00:44 Nursing in Malta: A Unique Perspective03:11 Historical Context of Nursing in Malta06:34 The Role of Nurses in Emergency Services11:37 Understanding Nursing: Capital N vs. Small n18:02 The Importance of Context in Nursing Care25:42 Holistic Care in Pre-Hospital Settings34:19 Building Trust and Relationships in Nursing40:48 Conclusions and Reflections on Nursing Practice

In this discussion, Dr. Tom Mallinson, a leader in remote medicine education with mountain rescue expertise, and Dr. Ella Corrick, a specialist in rural and expedition medicine, share their insights from the SOMA Conference. They tackle common challenges in austere medicine, highlight the importance of prolonged field care, and offer strategies for preparing for the Wilderness Paramedic Certification exam. The conversation emphasizes interactive learning, decision-making in medical scenarios, and the benefits of networking in advancing skills for remote practitioners.