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

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

Aebhric O'Kelly discusses Tactical Medicine North's efforts to enhance casualty care in Ukraine, focusing on damage control resuscitation. They train combat medics and non-medics through various courses, emphasizing blood resuscitation and prolonged casualty care. The urgent need for updated training protocols is explored, considering the realities of conflict. Continuous education is highlighted as essential for adapting medical practices, ensuring combat personnel are well-prepared for emergencies. The collaboration with global initiatives aims to elevate medical standards in challenging environments.

This week, Aebhric talks with Dr Sean Keenan, one of the founders of the Prolonged Field Care Working Group. They discuss his background and the development of PFC. They talk about creating the Austere Emergency Care course, which brings the lessons of prolonged field care to the civilian environment. He emphasises the importance of providing relevant and practical training that sparks interest and fosters collaboration among healthcare professionals. The conversation covers the benefits of being a non-profit organisation, the importance of continuous learning and humility in austere environments, the role of professional organisations like SOMA in supporting special operations medics, and the value of connecting with like-minded individuals in the field. The guests advise new paramedics, SOCM medics, nurses, and doctors interested in working in austere environments. Chapters 00:00 Introduction and Background 05:44 Formation of the Prolonged Field Care Working Group 30:20 The Creation of Specialized Medical Standards 40:16 The Benefits of Being a Non-profit Organisation 42:40 The Role of Professional Organizations in Supporting Special Operations Medics 45:04 Connecting with Like-Minded Individuals in the Field 49:02 Advice for new Paramedics, SOCMs, Nurses, and Doctors in working in austere environments   Takeaways The Prolonged Field Care Working Group was formed to address the need for extended medical care in austere environments by Sean Keenan, Paul Loos and Dennis Jarema. The group developed the Austere Emergency Care course to teach civilian remote medics the lessons of prolonged field care. The course is designed to provide relevant and practical training that sparks interest and fosters collaboration among healthcare professionals. Creating the Specialized Medical Standards non-profit organisation allows for the continued support and development of the Prolonged Field Care Working Group and the Austere Emergency Care course. A non-profit organisation can open doors and create opportunities in various fields, including medical and educational institutions. Continuous learning, humility, and being a team player are essential qualities for working in austere environments. Professional organisations like SOMA provide a platform for networking, exchanging ideas, and solving operational problems in special operations medicine. Connecting with like-minded individuals in the field can lead to valuable collaborations and sharing of knowledge and experiences. New paramedics, SOCMs, nurses, and doctors should focus on being excellent medical professionals, always learning, and acting in the best interests of their patients and teams.

This week, Aebhric O'Kelly talks with Rae Richburg, who attended almost three months of CoROM short courses this Spring term. Rae talks about her work as a registered nurse in prison psychiatric wards. She discussed her experiences spending three months in Pretty Bay, Malta, taking every CPD course on the schedule.

This week, Aebhric O'Kelly talks with Bobby Litton, a paramedic and teacher, and discusses his career and aspirations in pre-hospital medicine. He shares his experiences working in Iraq and the UK and his pursuit of advanced degrees and certifications. Bobby emphasizes the importance of continuous learning and surrounding oneself with knowledgeable and skilled individuals. He advises those interested in working in austere environments, including gaining experience through volunteering and investing in education.   Keywords paramedic, pre-hospital medicine, career, aspirations, experience, advanced degrees, certifications, learning, volunteering, education   Takeaways Continuous learning and self-improvement are essential in the field of pre-hospital medicine. To enhance your skills and knowledge, surround yourself with knowledgeable and skilled individuals. Gaining experience through volunteering and participating in expeditions can be valuable for working in austere environments. Investing in education and pursuing advanced degrees and certifications can open up opportunities for career advancement. Strive to be a better medic and constantly evaluate and improve your skills and knowledge.   Sound Bites "We all love trauma. It's all the primary care stuff that is our bread and butter." "The course is shifted to the environment with training paramedics to work in a pre-hospital condition that can provide the prolonged field care treatment in resource-poor environments without a lot of help."   Chapters  00:00 Introduction and Background 02:50 Paramedic Training and Challenges 07:52 Career Path and Future Plans 11:02 Working in the UK and Hospital Challenges 14:56 Transitioning to ACP and Specializations 25:08 Importance of Education and Continuous Learning 29:03 Teaching and Mentoring in Pre-hospital Medicine 32:00 Advice for New Paramedics and Healthcare Professionals