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

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.

This week, we explore various topics related to academic medicine in remote and austere environments that were presented during the Medicine in the Mediterranean conference in February 2025. The discussions include ventilation techniques in challenging settings, the impact of human factors in pre-hospital care, the importance of nursing care, and the complexities of treating critical casualties. We also delve into hyperbaric medicine, paediatric trauma, and the significance of mindset in medical practice. Each segment features insights from experts in their respective fields, providing valuable knowledge for medical professionals working in resource-limited areas.TakeawaysContinuous education is essential for effective patient care.Positive pressure ventilation can impact hemodynamic status.Human factors play a crucial role in pre-hospital care.Needle decompression techniques need proper training and feedback.Empathy in nursing care is vital for building trust with patients.Understanding the environment is key in treating critical casualties.Diving medicine requires awareness of hyperbaric risks and regulations.Urban environments significantly influence paediatric trauma.Mindset can shape a medical provider's legacy and effectiveness.Collaboration and communication are essential in emergency medical services.Chapters00:00 Introduction to the Quorum Podcast05:14 Ventilation in Austere Environments10:01 Human Factors in Pre-Hospital Care17:25 Needle Decompression in Pre-Hospital Care20:09 Nursing Care in Pre-Hospital Environments23:19 Treating Critical Casualties28:19 Hyperbaric Medicine and Diving Accidents33:19 Paediatric Trauma35:13 The Importance of Mindset

This week, Dr Sean Keenan gives the keynote address for the Medicine in the Mediterranean 2025 conference held last week in Malta. He discusses the evolution and current practices of Prolonged Field Care (PFC) in military and austere environments. Dr Sean Keenan discusses the importance of adapting medical practices to meet the challenges of remote and resource-limited settings, emphasising the need for comprehensive training and guidelines. The discussion highlights the difficulties with transitioning from Tactical Combat Casualty Care to Prolonged Field Care, the significance of clinical practice guidelines, and the ongoing efforts to improve emergency medical response in various contexts. This conversation delves into the development and implementation of Prolonged Casualty Care guidelines, focusing on the challenges faced in training and the importance of mastering basic medical skills. The discussion highlights the need for effective logistics, the significance of the golden hour in trauma care, and the evolving nature of warfare that impacts medical practices. The speaker emphasises the importance of continuous education and adapting to operational needs while maintaining sound medical principles. Takeaways Prolonged Field Care has evolved significantly over the past decade. The importance of audience participation in understanding medical terms. Learning from past experiences is crucial in medical practices. The Joint Trauma System collects data to improve best practices. Pre-hospital care is often overlooked in trauma literature. Human physiology remains constant regardless of the environment. Prolonged Field Care addresses the gaps in emergency medical response. Training and equipping personnel is essential for effective care. The transition from Tactical Combat Casualty Care to Prolonged Field Care is vital. Understanding the context of care is key to effective medical response. Prolonged Casualty Care guidelines are evolving to meet modern warfare needs. Curriculum development requires feedback from experienced practitioners. Basic medical skills are crucial for effective, prolonged field care. The golden hour is critical for reducing mortality in trauma cases. Logistics play a significant role in successful medical interventions. Training must adapt to the realities of current combat situations. Understanding human physiology is essential for effective medical care. Expecting casualty care is a new concept that needs training. Continuous education is vital for paramedics and medical personnel. Operational needs drive the development of medical guidelines. Chapters 00:00 Introduction to Prolonged Field Care 07:03 The Evolution of Prolonged Field Care 29:04 Current Practices and Guidelines in Prolonged Field Care 31:55 Prolonged Casualty Care Guidelines Overview 35:49 Curriculum Development and Feedback Process 40:12 Challenges in Prolonged Field Care Training 44:01 Extending the Golden Hour in Trauma Care 49:34 Current Practices and Future Directions in Prolonged Field Care 54:44 Mastering the Basics of Prolonged Field Care 01:00:42 Future Warfare and Operational Considerations

This week, Aebhric O’Kelly talks with a fellow Green Beret, Dr Glenn Barnes, who shares his unique journey from Special Forces to becoming a nursing educator specialising in aerospace and extreme environments. He discusses his military background, the transition to nursing, and his experiences in private military contracting. Dr Barnes emphasises the importance of innovative nursing education, particularly for veterans, and the need for nurses to be equipped to operate in austere environments. His insights reflect a deep commitment to military service and nursing, highlighting the interconnectedness of these fields. In this conversation, Glenn Barnes discusses the innovative nursing education programs he has developed, particularly in wilderness medicine and aerospace nursing. He emphasises the importance of experiential learning and the unique skill sets that nurses gain through these programs. The discussion also covers the challenges of providing prolonged field care in space, the historical context of nursing, and advice for new practitioners entering austere medicine. Barnes highlights the need for research and development in nursing practices for extreme environments and the significance of adapting to local conditions and resources. Takeaways Dr Barnes has a diverse background in military and nursing. He transitioned from infantry to nursing due to job availability. His experiences in the military shaped his nursing career. He emphasises the importance of teamwork in Special Forces. Dr Barnes developed programs to help veterans become nurses. He believes in empowering nurses to think outside the box. His courses focus on survival and disaster nursing. Veterans often struggle to utilise their skills in civilian life. The nursing programs he developed were intensive and rewarding. He aims to prepare nurses for challenging environments. The innovative nursing programs provide unique certifications. Experiential learning builds confidence in nursing students. Nurses play a crucial role in prolonged care in space. Research is needed for nursing practices in extreme environments. Historical perspectives on nursing inform current practices. Nursing education must adapt to new challenges in healthcare. Understanding local practices enhances medical care in austere settings. Nurses are essential for long-term patient care in space missions. Improvisation is key in austere medicine. Collaboration and research will shape the future of nursing. Chapters 00:00 Introduction to Dr Glenn Barnes 02:59 Military Background and Nursing Career 05:58 Transitioning from Military to Nursing 08:59 Experiences in Jump School and Special Forces 11:57 Private Military Contracting and Nursing 14:50 Developing Nursing Programs for Veterans 18:02 Innovative Nursing Education in Austere Environments 20:36 Aerospace and Extreme Environment Nursing 23:49 Challenges of Prolonged Field Care in Space 27:41 Developing Nursing Programs for Extreme Environments 30:43 Historical Perspectives on Nursing and Care 35:07 Advice for New Practitioners in Austere Medicine