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

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.

This week, we have another Medicine in the Mediterranean conference presentation. We will hear from Tactical Medicine North, a volunteer medical unit operating in Ukraine. The discussion covers their formation, mission, and challenges in training combat medics on the frontlines. Key topics include injury patterns, trauma management, blood logistics, and improved training in prolonged casualty care. The presenters emphasise the importance of adapting medical practices to the unique challenges of combat situations in Ukraine.TakeawaysTactical Medicine North was formed out of necessity due to the war in Ukraine.Training combat medics is crucial for effective frontline care.Injury patterns in Ukraine reveal a high incidence of non-combat injuries.TCCC is essential but needs adaptation to local conditions.Blood management logistics are a significant challenge in combat zones.Tourniquet use and wound management require more comprehensive training.Prolonged casualty care is often neglected in training programs.Collaboration with international organisations enhances training effectiveness.Understanding the unique challenges of Russian casualties is important for medical personnel.Future training must focus on nursing skills and prolonged care techniques.Chapters00:00 Introduction to Tactical Medicine in Ukraine02:49 The Formation and Mission of Tactical Medicine North05:12 Training and Challenges on the Frontline09:51 Understanding Injury Patterns and Casualty Statistics13:00 Trauma Challenges: TBI and Pre-Hospital Care20:28 Blood Management and Logistics in Combat23:43 Tourniquet Use and Wound Management26:58 Challenges with Russian Casualties and Evacuation30:23 Prolonged Casualty Care and Training Needs34:41 Conclusion and Future Directions

This week, Aebhric OKelly talks with Cory Igo, who is an alumnus of the CoROM Remote Paramedic programme. Cory shares his journey from being a United States Marine to becoming a remote paramedic, highlighting his experiences in veteran rehabilitation through Brazilian Jiu Jitsu, the challenges of working in remote medical settings, and the lessons learned from his deployments in Ukraine. He discusses the importance of adaptability in medicine, especially in challenging environments, and offers insights into the future of rehabilitation for injured veterans.TakeawaysCory Igo is a former Marine turned remote paramedic.Brazilian Jiu Jitsu aids in the rehabilitation of veterans.The transition from military to medical work can be challenging.Choosing the right paramedic program is crucial for practical skills.Cory's first paid job involved a reality show in Tanzania.Altitude sickness can affect individuals differently during climbs.Ukrainians are innovating in medical practices amidst conflict.3D printing is becoming significant in medical applications.Learning to adapt is essential for new medical professionals.Cory emphasises the importance of local knowledge in medicine.Chapters00:00 Introduction to Corey Igo03:01 The Role of Brazilian Jiu Jitsu in Veteran Rehabilitation06:04 Transitioning from Marine to Paramedic08:57 Choosing the Right Paramedic Program12:08 Experiences in Remote Paramedicine15:07 First Paid Job as a Paramedic17:57 Altitude Medicine and Climbing Kilimanjaro21:08 Working in Ukraine and Lessons Learned24:06 Future Aspirations in Rehabilitation27:09 Advice for New Medical Professionals

This week, Dr Jon Christensen discusses the critical role of mindset in medical practice, particularly in remote and resource-limited environments. He emphasises the importance of psychological first aid, decision-making under stress, and building resilience through self-care practices. Drawing from personal experiences and historical examples, Dr Christensen illustrates how mindset can shape outcomes in personal and professional contexts, ultimately leading to better patient care and personal growth.TakeawaysMindset significantly influences personal and professional outcomes.Understanding psychological first aid is crucial for first responders.Resilience can be built through self-care and awareness practices.Decision-making is often influenced by biases and heuristics.Isolation can lead to increased mental health issues.Nutrition and exercise play vital roles in mental well-being.Meditation and mindfulness can help manage stress and improve focus.Building connections and mentorship is essential for personal growth.Understanding one's legacy can motivate personal change.Success is defined by personal growth and the impact on others.Chapters00:00 Introduction to Mindset in Medicine03:08 The Importance of Mindset18:52 Risk and Decision-Making in Medicine27:03 Psychological First Aid and Its Importance33:10 Building Resilience and Self-Care49:20 Personal Journey and Lessons Learned

This week, Aebhric O’Kelly talks with Francois Duquette, a Quebec nurse who shares his unique experiences working in remote northern communities. He discusses the challenges of providing emergency care without immediate physician support, adapting nursing practices, and using technology like point-of-care ultrasound in austere environments. Francois recounts intense experiences, including multiplemedevacs and critical patient care situations, emphasising the need for continuous learning and training in unpredictable scenarios. He also offers valuable advice for new medics and nurses entering the field. TakeawaysFrancois has a diverse academic backgroundin political science and health law.He has worked in emergency care and remotenursing since 2017.Nurses in northern Quebec often workwithout immediate physician support.Adaptation of nursing practice is crucialin remote areas.Francois emphasizes the importance oftriage in emergency situations.Technology like POCUS is limited in remotehealthcare settings.Francois shares intense experiences fromhis nursing career.Continuous learning is essential forhealthcare professionals in austere environments.Language skills enhance communication andpatient respect in healthcare.Francois encourages new medics to embracechallenges and keep learning.Chapters00:00 Introduction to Francois Duquette01:53 Emergency Nursing in Remote Areas05:50 Challenges of Medical Practice Without Immediate Support09:50 Utilising Technology in Remote Healthcare13:55 Intense Experiences in Northern Nursing22:07 The Reality of Triage in Austere Environments28:03 Lessons Learned from High-Pressure Situations33:53 The Importance of Continuous Learning in Nursing39:59 Advice for New Medics and Nurses

This week, Aebhric O’Kelly talks with David Steade, who shares his journey through emergency medical services and military service. He details his experiences in Germany, his transition to the 160th Special Operations, and the challenges of flight medic training. He emphasizes the importance of continuous learning in the medical field and offers valuable insights for new medics and nurses entering austere medicine.TakeawaysDavid’s journey into EMS began in the 1990s.He experienced a culture shock when moving to Germany.His time in Germany included both medical training and cultural exploration.David transitioned to the 160th Special Operations for advanced training.Flight medic training was highly competitive and intense.The 160th is known for its role in special operations and support.David shared memorable medical cases from his time in the 160th.He emphasized the importance of learning from mistakes in medicine.David recommended practical advice for new medics entering austere medicine.Continuous learning is essential for all medical professionals.Chapters00:00nIntroduction to David Steade02:50 David's Journey into EMS and Military Service06:45 Experiences in Germany as a Medic09:23 Transitioning to the 160th Special Operations12:00 Flight Medic Training and Challenges18:14 Understanding the 160th Special Operations24:10 Memorable Medical Cases in the 160th28:00 Advice for New Medics and Nurses

Tropical medicine specialist Jason Jarvis, with an MSc in infectious disease, joins for an engaging discussion on malaria. He explains the complex lifecycle of malaria, emphasizing the role of Anopheles mosquitoes and the various stages of the parasite in humans. Jason delves into symptoms, diagnostic challenges, and effective treatments. The conversation highlights the promising R21 vaccine, focusing on childhood vaccination while exploring future adult trials. They discuss critical public health initiatives to combat this deadly disease and the need for robust information from trusted sources.

Daniel Grace, a pre-hospital GP and expedition doctor, shares his fascinating journey from conventional practice to the wild outdoors. He highlights the importance of an academic framework in expedition medicine and discusses the human factors that influence pre-hospital care. With memorable anecdotes from mountain rescue and his time in the Yukon, Grace emphasizes the value of tropical medicine and telemedicine initiatives like Virtual Doctors. He inspires aspiring expedition medics to embrace opportunities, leading to unexpected adventures.

This week, Aebhric O’Kelly talks with the new CoROM faculty, Dr Sean Bilodeau, an emergency physician and EMS fellow, and discusses his experiences and insights into the field of emergency medicine, mainly focusing on pre-hospital care and the evolving roles of paramedics. He highlights the differences between the US and European models of emergency medical services, the importance of education and training for paramedics, and the critical need for blood management in emergencies. Dr Bilodeau also shares his plans for research and education within the EMS field, emphasising the importance of community buy-in and the need for systemic changes in delivering pre-hospital care.TakeawaysDr Bilodeau is an ER doctor in Maine, completing an EMS Fellowship.He emphasises the importance of education in pre-hospital care.The US EMS model differs significantly from European models, particularly in physician involvement.There is a need for cultural change regarding paramedic roles in the US.Dr Bilodeau advocates for treating and releasing patients in the field when appropriate.He is involved in research on teaching critical skills to paramedics.The conversation highlights the logistical challenges of blood management in emergency care.Dr Bilodeau discusses the potential of using freeze-dried plasma in austere environments.He encourages new practitioners to seek opportunities and engage in projects actively.The finger thoracostomy is presented as a more effective technique than traditional needle decompression.Chapters00:00 Introduction to Dr Sean Bilodeau01:01 Emergency Medicine and EMS Fellowship02:34 Differences in Pre-Hospital Care Models05:31 Reimagining Paramedic Roles11:49 Future Plans and Research in EMS16:34 Global Perspectives on EMS Education21:55 The Importance of Blood in Emergency Care27:21 Challenges in Wilderness Medicine34:15 Advice for New Practitioners in Austere Medicine

In this engaging conversation, Dr. Derrick Tin, a Harvard professor specializing in critical care and counterterrorism medicine, shares insights from the unique field of disaster medicine. He emphasizes the need for practical training in resource-limited environments and discusses the psychological challenges faced by responders. Dr. Tin highlights the importance of mentorship, networking, and integrating disaster medicine into medical education. He calls for recognition of this specialty, underscoring its evolving nature in the medical community.