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

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

Dr. Hannah Evans, a rural GP and pre-hospital doctor with a wealth of experience in remote environments, shares her fascinating journeys, including work in Antarctica. She emphasizes the transformative role of telemedicine, especially in austere settings. Highlights include her experiences streaming medical data from Antarctic locations and her involvement in humanitarian projects globally. Dr. Evans passionately advocates for wilderness medicine education, sharing insights and advice for new practitioners aspiring to thrive in this challenging field.

This week, Aebhric O’Kelly talks with Dennis Jarema from the Prolonged Field Care Working Group. They discuss his journey from military service to nursing, emphasising the importance of prolonged field care in austere environments. They discuss the challenges faced in military medicine, the evolution of medical practices, and the establishment of the Prolonged Field Care Working Group. The conversation highlights the need for seamless integration of nursing care in emergencies and the importance of training and communication in improving patient outcomes. This conversation delves into the evolving nature of mnemonics in prolonged field care, the challenges faced in conducting research in austere environments, and the need for better communication and collaboration among practitioners and researchers. The discussion highlights the importance of mastering basic skills, avoiding training scars, and engaging volunteers to enhance the effectiveness of the Prolonged Field Care Working Group. The speakers emphasise the necessity of practical training and the development of a clearinghouse for sharing knowledge and resources in the field of austere medicine. Takeaways How Dennis' military background shaped his approach to medicine. The transition from Special Forces medic to nursing was driven by a desire for long-term patient care. Nursing provides essential skills for prolonged field care in austere environments. Understanding when to transition from emergency care to nursing care is crucial. The Prolonged Field Care Working Group was established to address gaps in military medical training. Training must include practical demonstrations of prolonged field care techniques. Communication and a common language are vital in multi-agency medical responses. The evolution of medical practices in the field reflects advancements in hospital medicine. There is a need for a combined paramedic-nurse training program in the U.S. Learning from international practices can enhance U.S. military medical training. Mnemonics in prolonged field care must evolve with practice. Research in prolonged field care faces significant challenges. There is a need for better communication between researchers and practitioners. Feasibility studies are crucial for understanding prolonged field care. Collaboration is essential for advancing research in austere medicine. The PFC Working Group plays a vital role in the community. Practical skills training is often lacking in current education. Engaging volunteers is key to the success of the PFC Working Group. Mastering the basics is fundamental for new practitioners. Experience is critical for recognising early signs of patient distress. Chapters 00:00 Introduction to Prolonged Field Care 00:45 Dennis' Military Journey 05:08 Transitioning to Nursing 10:52 The Importance of Nursing in Prolonged Care 17:11 Prolonged Field Care Working Group Origins 20:22 Challenges in Prolonged Field Care 26:35 Evolution of Medical Practices in the Field 29:58 Evolving Mnemonics in Prolonged Field Care 30:57 Challenges in Research for Prolonged Field Care 32:26 Bridging the Gap Between Research and Practice 34:52 The Need for Feasibility Studies 36:18 Collaboration in Prolonged Field Care Research 38:14 Establishing a Clearinghouse for Communication 40:36 Future Directions for the PFC Working Group 42:36 The Role of the PFC Working Group 44:03 Developing Practical Skills in Prolonged Field Care 45:32 Engaging Volunteers in the PFC Community 48:28 Mastering the Basics of Prolonged Field Care 50:55 Avoiding Training Scars in Medical Training 54:50 The Future of Prolonged Field Care Education 55:47 Advice for New Practitioners in Austere Medicine

This week, Aebhric OKelly talks with Michael Templeton, a flight paramedic for International SOS, and shares insights into his role, training, and experiences working in Guyana. He discusses the daily routines of a flight paramedic, the importance of training and qualifications, and the challenges faced in a tropical environment. Michael emphasises the need for confidence and leadership skills in emergency medical services and highlights the significance of postgraduate education in making informed decisions in critical situations. He also addresses safety concerns in Guyana and the measures taken to mitigate risks. In this conversation, Michael Templeton shares his extensive experiences in austere medicine, focusing on safety protocols, real-life rescue operations, and his response to the Ebola outbreak in Sierra Leone. He emphasises the importance of teamwork, adaptability, and continuous learning for medical professionals working in challenging environments.   Takeaways Michael Templeton has over six years of experience as a flight paramedic. He works in Guyana, primarily in oil and gas operations. A typical day includes meetings, briefings, and equipment checks. There is only one paramedic on duty at a time. Working in a busy EMS is essential for gaining confidence. Postgraduate education aids in decision-making for complex cases. Safety measures are crucial when working in high-risk environments. Paramedics must be prepared to make quick decisions. Training in various medical and rescue techniques is essential. Mitigating risks is key to ensuring safety in Guyana. Safety protocols are crucial in austere environments. Real-life rescue operations can be unpredictable and challenging. Injured individuals may require improvised care in remote locations. Understanding the risks and limitations of rescue missions is essential. Ebola response requires strict hygiene and safety measures. Teamwork and communication are vital in emergency situations. New medics should learn from experienced colleagues in the field. Adaptability is key when working in austere conditions. Continuous learning and skill development are important for medical professionals. Building relationships with local staff can enhance operational effectiveness.   Chapters 00:00 Introduction to Flight Paramedicine 02:55 A Day in the Life of a Flight Paramedic 06:10 Training and Qualifications for Flight Paramedics 08:53 Preparing for a Career in Flight Paramedicine 11:54 The Importance of Postgraduate Education 14:57 Safety and Risks in Guyana 25:55 Safety Protocols in Austere Environments 26:42 Real-Life Rescue Operations 38:59 Ebola Response in Sierra Leone 47:45 Advice for New Medics in Austere Medicine

This week, Aebhric OKelly talks with Daniele Manno, a graduate of the CoROM Remote Paramedic programme. He shares his unique journey from being a pilot to a paramedic, emphasising the importance of wilderness medicine and survival training. He discusses his experiences in clinical practice, particularly in trauma care, and reflects on the challenges and rewards of teaching remote life support courses. Daniele also highlights the need for a broader understanding of medical practices in austere environments and offers advice for new medics entering the field.   Takeaways Daniele transitioned from a 30-year career as a pilot to medicine at age 50. He emphasises that survival skills alone are insufficient without medical knowledge. Wilderness medicine training is crucial for those leading outdoor activities. Daniele's remote life support courses cover a wide range of medical situations. He believes curiosity is essential for deeper learning in medicine. His clinical experience in Africa provided hands-on learning opportunities. Daniele advocates for the recognition of paramedics in Italy's healthcare system. He stresses the importance of being broad-minded in austere medicine. Daniele's teaching aims to inspire students to pursue further medical education. He encourages new medics to be prepared for diverse medical challenges.   Chapters 00:00 From Pilot to Paramedic: A Unique Journey 09:13 The Importance of Wilderness Medicine 15:35 Transitioning to Remote Paramedic Training 27:38 Experiences in Clinical Practice 31:48 Preparing for the Future of Medicine

This week, Aebhric O’Kelly reflects on the highlights of 2024, showcasing insights from various guests who have contributed to the field of austere and remote medicine. The conversation covers prolonged casualty care, the importance of guerrilla medicine, and the challenges medics face in rural settings. The guests share their experiences and advice for new medics, emphasising the need for continuous learning and adaptability in the face of unique medical challenges.   Guests: Mike Turconi Dr Sean Keenan Dr Jaime Riesberg CJ Malcolm Antonio from EuroMedic Dr Jørgen Melau Dr Peter Anders Christiensen TacMedNorth from Ukraine   Takeaways 2024 has seen over 30,000 downloads from 43 countries. Austere medicine requires a different approach than traditional settings. Continuous learning is essential for medical professionals. Guerrilla medicine is becoming increasingly relevant in modern conflicts. Training in prolonged casualty care is crucial for medics in the field. Hyperthermia management is vital in cold operational settings. Rural populations often lack access to timely medical care. Improvisation is key in austere medical environments. Education is fundamental to improving medical practices worldwide. New medics should always strive to improve their knowledge and skills. You have to be prepared to improvise.   Chapters 00:00 Introduction to the CoROM Podcast 00:42 Highlights from 2024 Guests 06:09 Insights on Austere Medicine 09:29 Prolonged Casualty Care vs. Prolonged Field Care 13:12 The Importance of Guerrilla Medicine 15:10 Hyperthermia in Operational Settings 18:40 Challenges in Rural and Austere Medicine 20:27 Nordic Special Operations Combat Medic Program 23:09 Training Medics in Ukraine 27:24 Final Advice for New Medics

This week, Aebhric O’Kelly talks with Nick Hill about his extensive experience in military nursing, detailing his journey from the New Zealand Defence Force to the Danish military. He discusses the roles he has held, the challenges faced in various environments, and the importance of improvisation in medical practice. Nick emphasises the need for continuous learning and adaptation in austere medicine, drawing insights from his Austere Emergency Care course participation. He also highlights the cultural differences between military practices in different countries and the importance of collaboration in improving medical care. Takeaways Soldering is a universal concept across different militaries. Improvisation is crucial in austere medical settings. Continuous learning is essential for medical professionals. Cultural differences impact military medical practices. The importance of teamwork in emergency care. Adaptation and improvisation can enhance clinical practice. Engaging civilians in medical training is vital. Nordic countries show a strong commitment to medical readiness. Understanding logistics is key in prolonged field care. Seek knowledge from diverse sources for better practice. Chapters 00:00 Introduction to Nick Hill's Military Journey 03:12 Roles and Responsibilities in New Zealand's Military 05:57 Transitioning to Denmark and Cultural Differences 09:00 Experiences in Australia and Unique Challenges 11:56 Austere Emergency Care Course Insights 15:06 Improvisation in Medical Practice 18:08 Learning from Diverse Medical Environments 20:53 Advice for New Medics in Austere Medicine

This week, Aebhric O’Kelly talks with Dr Jørgen Melau. They discuss the intricacies of providing prolonged field care (PFC) in Arctic environments. They emphasise the importance of knowledge over gear, the challenges of managing cold casualties, and the necessity of shelter and improvisation. The discussion also covers protocols for PFC, the difficulties of vapour barriers, transportation strategies, and future developments in Arctic medical care. Dr Melau provides valuable advice for new medics interested in working in cold environments, highlighting the need for comfort and experience in such conditions.   Takeaways Knowledge is more vital than the actual gear. Training should focus on the person, not just products. Shelter is vital for casualty care in the Arctic. Improvisation can save lives in cold environments. Condensation is a considerable problem in cold weather operations. Breathable fabrics could improve vapour barriers. Keeping hands warm is vital for medics in cold environments. You must be comfortable in the cold before being a medic. Training in cold environments is essential for medics. Human performance is key in prolonged care situations.   Chapters 00:00 Introduction to Arctic Prolonged Field Care 01:10 The Importance of Knowledge Over Gear 07:04 Managing Cold Casualties in the Arctic 11:37 Shelter and Improvisation Techniques 17:00 Protocols for Prolonged Field Care 23:02 Challenges of Vapor Barriers and Heating 30:03 Transportation and Evacuation Strategies 34:48 Future Developments in Arctic PFC 44:58 Advice for New Medics in Cold Environments