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

This week, Aebhric O’Kelly talks with Dr Jamie Riesberg, who created the separation of Prolonged Casualty Care (PCC) from Prolonged Field Care (PFC). Dr Riesberg has extensive experience in military medicine, focusing on the evolution of prolonged field care and the transition from the Global War on Terror (GWOT) to future conflicts. He emphasises the importance of adapting medical training to current battlefield realities, including lessons from Ukraine. Dr Riesberg advocates for a shift in mindset towards PCC and the need for continuous hands-on experience for medics. They also discuss the challenges posed by policy and training limitations, urging a more robust approach to medical care in combat situations. Takeaways Prolonged field care is essential for future military operations. Past conflicts influence the evolution of military medicine. NATO plays a crucial role in standardising medical training. Lessons from Ukraine highlight the need for adaptability in medical care. Medics must be prepared for prolonged care situations. The environment significantly impacts medical decision-making. Continuous training and hands-on experience are vital for medics. Policy changes are necessary to enhance medical training opportunities. Expectant casualty management is a growing concern in military medicine. Curiosity and creativity are critical traits for success in austere medicine. Chapters 00:00 Introduction to Dr. Jamie Riesberg 02:54 The Evolution of Military Medicine 05:48 The Importance of Prolonged Field Care 09:02 Transitioning from GWAT to LISCO 12:04 The Role of NATO in Medical Training 15:00 Lessons from Ukraine and Future Conflicts 17:49 The Concept of Prolonged Casualty Care 20:51 Challenges in Training and Policy 24:05 The Future of Medical Care in Combat 27:03 Advice for New Medics in Austere Medicine

This week, Aebhric O’Kelly talks with Eric Holmstrom and Laszlo Hegedus about creating a new faculty within CoROM. They discuss their recent activities, including organising law enforcement competitions and teaching various medical courses. They highlight the importance of hands-on training and the need for continuous learning in operational medicine. The conversation also touches on the upcoming developments at the college, such as the establishment of the Faculty of Operational Medicine and the implementation of new monitoring devices for patient care. They emphasise the importance of documentation and research in improving medical practices. The discussion concludes with advice for healthcare professionals starting their careers. keywords operational medicine, law enforcement competitions, medical courses, hands-on training, continuous learning, college developments, Faculty of Operational Medicine, monitoring devices, documentation, research, advice for healthcare professionals Takeaways Hands-on training and continuous learning are essential in the field of operational medicine. The college is establishing the Faculty of Operational Medicine to bring together subject matter experts and advance the field. Implementation of new monitoring devices and documentation systems can improve patient care and facilitate research. Healthcare professionals should be bold and ask questions, seek learning opportunities, and get involved in patient care. Interoperability and adherence to evidence-based guidelines are crucial in providing quality medical care. Chapters 00:00 Introduction and Recent Activities 03:16 Teaching Experiences and Motivated Students 06:05 Improvisation and Moulage Training 09:20 The Importance of Tropical Medicine 13:02 The Growing Momentum of Ultrasound Training 17:59 The Need for Prolonged Field Care and AEC Courses 19:39 The Faculty of Operational Medicine 22:16 Implementing New Monitoring Devices and Documentation Systems 27:29 NEAMT Certification and Offering Additional Courses 29:39 Advice for Healthcare Professionals Starting Their Careers

Cole Shaver and Graydon Ratushny are paramedics working in British Columbia who share their experiences working in Kibosho District Hospital in Moshi, Tanzania, as part of the Austere Critical Care Master's program. They discuss the challenges of practising medicine in a resource-limited setting and the importance of improvising and adapting clinical skills to the local context. They highlight basic clinical assessments, such as percussion and auscultation, and the value of non-technical skills in making diagnoses and providing care. They also discuss the social determinants of healthcare and the impact of a user-pay system on patient access to medical services. The conversation explores the themes of telehealth and remote health assessments, the importance of old-school clinical skills, the resilience of patients in resource-limited settings, the use of CPAP in rural healthcare, the value of the CoROM Field Guide, and the benefits of international healthcare experiences. takeaways Adapting clinical skills to a resource-limited setting is crucial for providing effective care. Basic clinical assessments, such as percussion and auscultation, can be valuable tools without advanced diagnostic equipment. Non-technical skills, such as observation and clinical gestalt, play a significant role in making diagnoses and guiding treatment decisions. The social determinants of healthcare, including a user-pay system, can profoundly impact patient access to medical services. Telehealth and remote health assessments are shaping the future of healthcare, allowing for transmitting imaging and audio findings to specialists in established facilities. Old-school clinical skills, such as physical assessments and clinical signs, are underappreciated in Western medicine but highly relevant in resource-limited settings. Patients in rural and remote areas are often more resilient than expected, and healthcare providers can take a step back and gather more information before intervening. CPAP devices can effectively manage respiratory distress in resource-limited settings, and collaborative teaching and learning between healthcare professionals from different backgrounds is invaluable. The CoROM Field Guide is a valuable resource for remote and rural clinicians. It provides essential information and prompts when data connectivity is limited. International healthcare experiences provide a broader perspective and appreciation for different healthcare systems and practices, fostering collaboration and knowledge sharing. Chapters 00:00 Introduction and Background 03:00 Adapting Clinical Skills in a Resource-Limited Setting 08:34 The Value of Basic Clinical Assessments 13:42 The Role of Non-Technical Skills in Diagnosis 20:04 The Impact of Social Determinants on Healthcare Access 29:48 The Future of Healthcare: Telehealth and Remote Assessments 32:23 The Value of Old School Clinical Skills in Resource-Limited Settings 35:35 Resilience of Patients in Rural and Remote Areas 39:23 CPAP: A Game-Changer in Resource-Limited Healthcare 52:51 The Quorum Field Guide: A Must-Have for Remote Clinicians 56:11 The Benefits of International Healthcare Experiences

This week, Aebhric O’Kelly talks with Ronin's founder, Timm Smith, who shares his journey from being a lawyer to becoming a close protection officer and paramedic. He discusses the importance of being a whole bodyguard, protecting clients from external and internal threats. Tim emphasises the need for excellence, reality, and truth in the close protection industry. He also highlights the value of training paramedics to be close protection officers and vice versa. The conversation touches on the impact of Gregorii Tsekmistrenko's death, a Ronin graduate, and the importance of humility and learning from mistakes in austere medicine. https://www.ronin.co.za/ Takeaways Being a whole bodyguard means protecting clients from both external and internal threats. Excellence, reality, and truth is essential in the close protection industry. Training paramedics to be close protection officers and vice versa is a valuable career path. Humility and learning from mistakes are crucial in austere medicine. Chapters 00:00 Introduction and Background 07:11 From Law to Close Protection 10:29 Becoming a Paramedic 17:33 Founding Ronin: A Centre of Excellence 24:23 The Connection to Malta 28:30 Training Paramedics in Close Protection 35:02 Remembering Gregorii Tsekmistrenko 38:03 Advice for New Medics

This week, Aebhric O’Kelly talks with John Clark, the College's Executive Dean, about the new 2024-2025 academic year. They discuss the recent developments and plans for the college. John discusses the college's collaborations with organisations like WMS and IBSC and upcoming trips to Ghana and Tanzania. He also mentions the expansion of the college's facilities and the launch of a peer-reviewed journal. The conversation concludes with advice for healthcare professionals starting their careers in austere medicine. takeaways The college has launched the doctorate in health studies and has seen growth in the bachelor's program in remote paramedic practice. The Master's in Austere Critical Care program is also growing, and the college is launching a new Master's in Global Health program. The college collaborates with organisations like WMS and IBSC and is working to expand the reach of paramedic certifications. Upcoming trips to Ghana and Tanzania will focus on establishing new clinical sites and improving existing ones. The college is expanding its facilities and launching a peer-reviewed journal called the Journal of Improvised Medicine. Advice for healthcare professionals starting their careers in austere medicine is to seek education and continuously improve their skills. Chapters 00:00 Introduction and Overview 01:03 Recent Developments and Plans for the College 02:30 Expanding Programs and Collaborations 04:52 Trips to Ghana and Tanzania 10:41 Facility Expansion and Peer-Reviewed Journal 18:30 Advice for Healthcare Professionals in Austere Medicine

This week, Aebhric OKelly interviews Bill Vasios, a physician assistant who started as an 18 Delta and had several other 18 series jobs. Bill is pursuing a PhD in education focusing on instructional design and technology. He is also doing a simulation fellowship at East Carolina University. They talk about online learning, designing a perfect online learning system, the challenges of teaching in the medical field, and the importance of credible sources in education. Takeaways Bill is a physician assistant with a background in the military, having served as an 18 Delta and held other 18 series jobs. He is pursuing a PhD in education, focusing on instructional design and technology. Bill discusses the challenges and benefits of online learning and the importance of credible sources in education. He also discusses the need for adaptive and interactive learning systems in medicine. Stay thirsty for knowledge and continuously learn throughout your career. Ultrasound is a valuable tool for Special Forces medics, but training and sustainment are crucial. Hands-on training and mentorship are essential for developing ultrasound skills. Effective teaching requires authenticity, care, and adapting to individual learning needs. The art of teaching lies in respectfully challenging and guiding students to improve their skills. Access to ultrasound equipment and regular scanning practice are necessary for maintaining competence. The ability to compare normal and injured scans is valuable for identifying abnormalities. Being surrounded by excellent people raises everyone's skills and abilities. Chapters 00:00 Introduction and Correction of Name 01:31 Bill's Background and Current Pursuits 08:18 Designing an Adaptive Learning System 12:22 The Challenges of Teaching in the Medical Field 14:12 The Future of Online Learning in the Medical Field 16:24 Balancing Online and Face-to-Face Learning 18:12 The Importance of Credible Sources in Education 23:51 Creating Curriculum for Soft Medics 24:29 Getting to Know Bill Vasio 30:12 Bill's Military Background and Transition to PA 33:39 Bill's Military Journey and Learning Code 35:10 Selection and Robin Sage 38:52 Becoming a PA and Returning to SF 40:47 The SOLCUS Program and Ultrasound in SF 43:04 Special Operator Level Clinical Ultrasound Programme and Advancements in Ultrasound 45:00 Sustaining Ultrasound Skills in 18 Delta Medics 49:04 Advice for New Medics and the Importance of Continuous Learning 53:05 The Art of Effective Teaching and Mentoring 56:30 Challenges of Ultrasound Training and Sustainment 01:05:00 Conclusion and Final Thoughts

This week, Aebhric O’Kelly talks with Antonio from European Medics about their work and focus on guerrilla, austere, and remote medicine. European Medics started as a community of passionate individuals in emergency medicine and has grown to focus on education and enhancing medicine. European Medics is currently working on creating training material and educative resources for their Advanced Guerrilla First Responder (AGFR) course. European Medics (EURMED) is focused on providing evidence-based guidance in unconventional and guerrilla medicine. Guerrilla medicine overlaps with other fields, such as wilderness medicine, medical support for irregular warfare, and disaster relief. The goal is to be better prepared for future conflicts and disasters and to save lives. Takeaways European Medics started as a community of passionate individuals in emergency medicine and has grown to focus on education and enhancing medicine. They are currently working on creating training material and educative resources for their Advanced Guerrilla First Responder (AGFR) course. European Medics has a podcast with multiple shows, including medical basics, field clinic, and long-format discussions with subject matter experts. Their goal is to provide training and education in austere and remote medicine to enhance the capabilities of healthcare providers in resource-limited environments—European Medics evidence-based guidance in unconventional and guerrilla medicine. EURMED has published a paper on gorilla medicine and plans to publish more papers on the topic. EURMED aims to be a neutral ground for the medical community to exchange experiences and provide expert medical education. The future of guerrilla medicine is seen as an integrated part of forward medicine, focusing on providing care to civilians affected by conflicts. Guerrilla medicine overlaps with other fields, such as wilderness medicine, medical support for irregular warfare, and disaster relief. The goal is to be better prepared for future conflicts and disasters and to save lives. Chapters 00:00 Introduction and Background 03:10 European Medics: Community and Education 06:12 The Advanced Guerrilla First Responder Course 09:02 Podcast: Medical Basics and Field Clinic 23:02 Publishing Concepts and Lessons Learned in Ukraine 27:11 The Future of European Medics 29:13 European Medics: A Neutral Ground for Medical Education 31:37 Expanding European Medics to the United States 36:48 Guerrilla Medicine and Overlapping Fields 41:37 The Clandestine Nature of Guerrilla Medicine 44:45 Preparing for Future Conflicts and Disasters 46:51 Advice for New Medical Professionals

This week, Aebhric talks with Dr Alastair Fraser, chair of the faculty advisory board for the Faculty of Remote Rural and Humanitarian Health care for the Royal College of Surgeons of Edinburgh, and discusses his diverse medical career and experiences in remote and rural areas. He shares stories from his time in the Antarctic, Nigeria, and with Shell, highlighting the challenges and unique situations he encountered. Dr Fraser also discusses the importance of mental health support for medics in remote locations and the need for ongoing training and resources. The conversation discusses the creation and purpose of the Faculty of Rural Remote Humanitarian Health, a specialised area under the Royal College of Surgeons of Edinburgh. The faculty aims to provide training and recognition for healthcare professionals in remote, rural, and humanitarian settings. It addresses the challenges of delivering healthcare in these areas and seeks to improve the quality of training and competence. The conversation also highlights the importance of community and networking among professionals in these fields. The faculty offers fellowship and membership to individuals who have demonstrated competence and contribution to the field. Takeaways Dr Alastair Fraser has had a diverse medical career, working in remote and rural areas and with Shell in various locations. He emphasises the challenges and unique situations in remote healthcare, where medics are often asked to handle various medical issues. Dr Fraser highlights the importance of mental health support for medics in remote locations and the need for ongoing training and resources. He discusses the potential benefits of incorporating ultrasound devices into the toolkit of offshore medics but acknowledges the challenges in implementing this due to company policies and liability concerns. The Faculty of Rural Remote Humanitarian Health is a specialised area under the Royal College of Surgeons of Edinburgh that provides training and recognition for healthcare professionals working in remote, rural, and humanitarian settings. The faculty addresses the challenges of delivering healthcare in these areas and aims to improve the quality of training and competence. Membership in the faculty is open to anyone interested in the field, not just doctors or medics. The faculty plans to offer more online courses that cover various skills needed in remote, rural, and humanitarian healthcare. The faculty is voluntary and relies on volunteers and funding to operate. Networking and community-building among professionals in these fields are important for sharing ideas and experiences. The faculty is working towards providing educational credits and accreditation for its courses. Healthcare professionals interested in working in austere environments should seek training, talk to experienced professionals, and develop skills in working under pressure and uncertainty. Chapters 00:00 Introduction and Background 02:10 Experiences in the Antarctica 03:00 Challenges and Unique Situations in Remote Healthcare 08:05 Limited Medical Resources in Remote Locations 15:23 Importance of Mental Health Support for Medics 20:21 Implementing Ultrasound for Offshore Medics 21:10 Introduction to the Faculty of Rural Remote Humanitarian Health 23:50 Challenges of Delivering Healthcare in Remote and Rural Areas 27:35 Membership and Community in the Faculty 33:57 Expanding Online Courses for Remote Healthcare 39:02 The Humanitarian Healthcare Course and Accreditation 43:47 Advice for Healthcare Professionals in Austere Environments

This week, Aebhric talks with Frida Svahn, a nurse from Sweden, who discusses her experiences teaching medical training in various countries and her work with the Swedish Civil Contingencies Agency (MSB). She shares her journey from serving in the Swedish Armed Forces to becoming a nurse and her passion for working in austere environments. Frida highlights the importance of training the trainers and its impact in countries like Ukraine. She also mentions the upcoming National Seminar Exercise in Sweden and the role of MSB in civil defence and NATO. Frida advises new healthcare professionals interested in working in austere environments to invest in good courses, build a network, and stay motivated.   Takeaways Teaching medical training in austere environment is a rewarding experience that allows healthcare professionals to make a difference in countries like Ukraine. MSB plays a significant role in civil defence and NATO, providing training and expertise in emergency response and crisis management. Investing in good courses, building a network, and staying motivated are essential for healthcare professionals working in austere environments. Training the trainers is a force multiplier that spreads knowledge and skills to a larger population. Sweden's upcoming National Seminar Exercise will involve multiple nations, focusing on casualty move and patient flow management.

This week, Aebhric O'Kelly talks with Dr John Quinn and Eirik Holmstrøm, who all went to Ukraine to teach the Damage Control Resus Ukraine (DCRU) course. They discuss the curriculum, the use of clinical practice guidelines (CPGs), and the importance of access to blood in the pre-hospital setting. They highlight the collaboration with Tactical Medicine North and the professional partner forces in Ukraine. The hosts also mention the Defence Health Administration's (DHA) role and the resources on the DHA website and app. The conversation emphasises evidence-based practices and knowledge exchange's significance in improving military medicine. The conversation focuses on the challenges and solutions in Ukraine's implementation of damage control resuscitation (DCR). The speakers discuss the need for interoperability in large-scale combat operations (LSCO) and the importance of rethinking traditional medical practices. They highlight the limitations of blood transfusion in the field and the need for a logistic system to support the transportation of blood. The conversation also covers training Ukrainian combat medics in advanced skills such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and ultrasound. The speakers emphasise the importance of continuous learning, adapting to failures, and the potential for DCR to increase combat effectiveness in Ukraine. Keywords Damage Control Resus Ukraine, DCRU, curriculum, clinical practice guidelines, CPGs, pre-hospital setting, blood access, Tactical Medicine North, partner forces, Defence Health Administration, DHA, evidence-based practices, military medicine, damage control resuscitation, interoperability, large-scale combat operations, blood transfusion, logistic system, training, combat medics, REBOA, ultrasound, continuous learning, combat effectiveness Takeaways The DCRU course in Ukraine focused on damage control resuscitation in the pre-hospital setting. The curriculum was based on clinical practice guidelines (CPGs) from the Defence Health Administration (DHA). Access to blood and blood components was highlighted as crucial in effective care. Collaboration with Tactical Medicine North and professional partner forces in Ukraine was instrumental in the course's success. The DHA website and app provided valuable resources for learning and reference in austere environments. The exchange of knowledge and lessons learned is essential for improving military medicine. Implementing damage control resuscitation in large-scale combat operations requires interoperability and a logistic system to support the transportation of blood. Traditional medical practices need to be rethought to align with the evolving nature of warfare. Training combat medics in advanced skills such as REBOA and ultrasound can improve patient care and increase patient transport confidence. Continuous learning and adapting to failures are essential in austere medicine. Damage control resuscitation has the potential to increase combat effectiveness in Ukraine. Chapters 00:00 Introduction to Dr John Quinn and Eirik Holmstrom 02:07 Adding Co-Authors and References 04:01 Introduction to the DCRU Course 08:09 Overview of the DCRU Curriculum 13:49 Importance of Access to Blood 16:40 Acknowledging the Defence Health Administration 18:56 Interoperability and Logistic Challenges 23:35 Rethinking Traditional Medical Practices 29:24 Training Combat Medics in Advanced Skills 38:34 Continuous Learning and Adapting to Failures 41:10 The Potential of Damage Control Resuscitation