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

This week, Aebhric O'Kelly speaks with Axel Ernir Viðarsson, an advanced EMT, firefighter and search and rescue instructor based in Akureyri, northern Iceland.

With more than 20 years of volunteer search and rescue experience, Axel offers fascinating insight into Iceland's emergency medical services, wilderness rescue operations, and the challenges of delivering prehospital care in one of Europe's most geographically demanding environments.

Chapters

00:00 – Introduction to Axel Ernir Viðarsson

01:18 – Rescue 26: Iceland's International Search and Rescue Conference

03:27 – Bringing Prehospital Ultrasound to Iceland

05:39 – The Future of POCUS in Icelandic Ambulance Services

07:15 – Firefighting, Ambulances and Fixed-Wing Air Evacuation

09:55 – What Is a Smoke Diver?

11:34 – How Iceland's EMS and Search and Rescue Systems Work Together

13:26 – Volcanic Eruptions and Search and Rescue Operations

16:29 – Tourist Rescues, Blizzards and Wilderness Emergencies

17:56 – Iceland's Paramedic Education and Overseas Training

19:41 – Designing the Ideal Icelandic EMS System

21:22 – Advanced EMT Training in Iceland

24:44 – Could CoROM's BSc Remote Paramedic Practice Work in Iceland?

27:17 – Prolonged Patient Care in Iceland's Remote Wilderness

29:32 – Coordinating EMS, Search and Rescue and Air Ambulance Evacuation

32:29 – Choosing Between Akureyri and Reykjavík Hospitals

33:26 – When the Patient Is Nothing Like the Dispatch Report

34:29 – Axel's Journey into Search and Rescue

37:06 – Becoming a Wilderness Medicine Instructor

38:54 – Teaching, Avalanche Rescue and Wilderness First Aid

40:11 – Why Austere Medicine Makes Better Clinicians

41:21 – Learning from Students and Fellow Instructors

42:32 – Advice for New Austere Medicine Practitioners

43:38 – Getting Involved in Conferences and Professional Education

44:26 – Final Thoughts and Future CoROM Training in Iceland

Topics Discussed

- Icelandic emergency medical services and advanced EMT practice

- Volunteer search and rescue and the Icelandic Association for Search and Rescue (ICE-SAR/ISAR)

- Volcanic eruptions, avalanche rescue and wilderness emergencies

- Fixed-wing air ambulance operations and Coast Guard helicopter evacuation

- Prolonged field care and remote patient transport

- Point-of-care ultrasound in prehospital medicine

- Advanced EMT and paramedic education pathways

- International collaboration in remote paramedic education

- Wilderness medicine instruction and professional development

- The importance of networking, conferences and lifelong learning

This week, Aebhric O'Kelly speaks with John Crofts, a nurse working at Zuckerberg San Francisco General Hospital, the city's Level I trauma centre. John brings an extraordinary perspective to austere medicine, combining emergency nursing, humanitarian logistics, infectious disease research and international humanitarian advocacy.

Chapters

00:00 – Introduction: Meet John Crofts, emergency nurse and humanitarian advocate.

00:46 – Nursing at San Francisco General: Working in a Level I trauma centre.

02:10 – Violence and Burnout in Emergency Departments: A pilot programme addressing patient agitation and healthcare worker wellbeing.

04:14 – When Violence Compromises Critical Care: How competing demands divert resources from critically ill patients.

06:19 – Healthcare Violence and Ebola: Parallels between American emergency departments and humanitarian responses in resource-limited environments.

08:38 – When Patients Lose Trust in Healthcare: Inequality, frustration and violence against healthcare workers.

09:20 – Why Study Austere Medicine?: John's interest in CoROM and international humanitarian medicine.

10:16 – Humanitarian Logistics and Advocacy: Learning from clinicians working in Somalia, Ukraine and other challenging environments.

11:20 – The ICARE Experience in Malta: What John gained from the course.

12:19 – Learning from Other Clinicians: Scenario-based training, shared experience and challenging clinical assumptions.

14:31 – Bringing Austere Medicine Back to San Francisco: Why experienced emergency nurses can benefit from resource-limited training.

16:56 – Gunshot Wounds Outside the Hospital: When critical care begins on the street with minimal resources.

18:28 – An Unconventional Journey into Nursing: How John found his way into healthcare.

19:15 – From Helicopter Pilot to Humanitarian Logistics: Aviation, maritime operations and the importance of logistics.

20:41 – Nursing Education in Micronesia: Training at a hospital in Palau.

23:00 – Refugee Advocacy in Palau: Working with displaced Uyghur former Guantánamo detainees.

24:00 – Clearing Explosive Remnants of War: Humanitarian demining and environmental hazards in the Pacific.

25:20 – From Alaska to Austere Medicine: How John's experiences shaped his clinical and humanitarian interests.

26:55 – Studying Infectious Disease: The London School of Hygiene & Tropical Medicine and global health research.

27:30 – Sierra Leone After Ebola: Questions about outbreak preparedness and the sustainability of international aid.

28:51 – What's Next for John?: Returning to humanitarian work and strengthening healthcare systems.

30:00 – Bioethics and Global Health: Ethical challenges involving technology, resource allocation and healthcare inequality.

31:01 – Humanitarian Medicine Beyond Academia: Why practical advocacy remains important.

33:26 – Humanitarian Work in Myanmar: Landmines, local communities, political pressures and deportation.

35:39 – Research, Publications and Advocacy: Sharing lessons from humanitarian practice.

36:28 – Advice for New Austere Clinicians: Following an unconventional career path and embracing uncertainty.

38:32 – Compassionate Care in Challenging Systems: Why healthcare professionals must advocate for patients and meaningful change.

39:15 – Closing Thoughts: The importance of learning, professional relationships and returning to Malta.

This week, Aebhric O’Kelly catches up with Dmytro following his graduation from CoROM’s BSc in Remote Paramedic Practice and his successful registration as a paramedic with the UK Health and Care Professions Council (HCPC).

Dmytro describes his current work providing medical care on a remote Caribbean island and reflects on previous roles in humanitarian and military medicine in sub-Saharan Africa. He explains why working remotely requires a different clinical mindset—particularly when weather, geography or resources prevent evacuation, and a patient may remain in your care for hours or even days.

Chapters

00:00 – Welcome Back, Dmytro: From CoROM graduate to HCPC-registered paramedic.

00:33 – Remote Medicine in the Caribbean: Providing healthcare for thousands of guests and staff on a private island.

01:30 – An ICU on a Remote Island: Ventilation, capnography, laboratory diagnostics, POCUS and advanced monitoring.

02:58 – Paramedics Doing Radiography: The expanding role of the remote paramedic.

03:18 – From Africa to the Caribbean: Humanitarian medicine, military medicine and remote clinic operations.

04:40 – Qualifications for Remote Paramedic Work: How education and operational experience helped Dmytro secure his current position.

05:33 – Why CoROM?: Why one year of paramedic education wasn't enough and why Dmytro continued through the full BSc.

07:20 – Becoming a UK-Registered Paramedic: Starting the HCPC international registration process.

09:27 – HCPC Standards of Proficiency: Demonstrating education, experience, autonomy and clinical competence.

11:36 – Lessons from the HCPC Application: Documentation mistakes that can add weeks or months to the process.

13:58 – AI, Plagiarism and HCPC Applications: Why applicants need to ensure their submission is genuinely their own work.

14:15 – The First HCPC Assessment: Where additional evidence was required.

15:58 – Preparing for the Test of Competence: UK clinical guidance, common conditions and targeted preparation.

18:17 – UK Law and Paramedic Practice: Consent, safeguarding, mental capacity, resuscitation and verification of death.

18:50 – What Happens During the Test of Competence?: Clinical scenarios and assessment by practising NHS paramedics.

20:38 – Finally Registered: Completing an eight-month HCPC journey.

21:31 – What This Means for CoROM Graduates: Dmytro's pathway as a BSc Remote Paramedic Practice graduate.

22:03 – Graduation and the People Behind the Degree: Recognising the instructors and clinicians who shape a paramedic.

23:21 – Advice for Future BSc Students: Patience, practical training and making the most of KCMC.

25:09 – What Comes After the BSc?: MSc Austere Critical Care, offshore medicine and diving medicine.

26:19 – Does Austere Training Change How You Practise?: Why remote medicine requires a different professional perspective.

26:39 – Hospital Skills vs Remote Skills: Lessons from military medicine in sub-Saharan Africa.

28:29 – When You Cannot Evacuate: Managing patients for hours or days aboard ships and in remote locations.

29:40 – What Would Dmytro Do Differently?: More pharmacology, more KCMC and more exposure to ICU practice.

30:46 – Hurricanes, No Helicopter and No Boat: Why remote clinicians need critical care skills when evacuation fails.

31:40 – Advice for New Austere Clinicians: Learn remote medicine from people who actually work in resource-limited environments.

32:45 – Looking Back on the Journey: From student to degree-qualified, HCPC-registered remote paramedic.

32:56 – Acknowledgements: Dmytro thanks the CoROM faculty, colleagues and organisations that supported his journey.

34:20 – Closing Remarks: Continuing the journey in austere and remote medicine.

This week, Aebhric O’Kelly is joined by Rob Schembri, a Canadian critical care paramedic with Ornge, Ontario’s air ambulance service, and a student on CoROM’s MSc in Austere Critical Care.

Rob discusses his journey through critical care paramedicine, his recent move onto a special operations team and why, after decades in the profession, he decided to pursue postgraduate education in austere medicine. His new role includes supporting the transport of patients with high-risk pathogens and mechanical cardiac support, as well as USAR and other specialist operations.

The conversation explores the Canadian paramedic system, including the progression from Primary Care Paramedic to Advanced Care Paramedic and ultimately Critical Care Paramedic. Rob explains the extensive training required at the critical care level and how international paramedics can enter the Ontario system.

Rob also talks candidly about undertaking his first research project, navigating ethics approval and discovering that the thesis he initially dreaded has become one of the most interesting parts of his MSc.

The episode finishes with a discussion about lifelong learning, career development and Rob’s advice to clinicians beginning a career in austere medicine: learn as much as you can, experience as much as you can—and enjoy what you do.

Chapters

00:00 – Meet Rob Schembri: Critical care paramedicine, Ornge and joining the special operations team.

01:18 – The Malta Connection: Rob's Maltese heritage and his family's move to Canada.

03:03 – Returning to Malta for a Master's Degree: The irony of pursuing postgraduate education in the country his parents left.

03:25 – Why the MSc in Austere Critical Care?: Preparing for specialist critical care and special operations.

05:02 – High-Risk and Special Operations Medicine: High-risk pathogens, mechanical cardiac support, USAR and specialist transport.

06:50 – Why Study Austere Critical Care in Malta?: Choosing CoROM rather than a conventional Canadian critical care programme.

08:18 – POCUS and Future Training: Bringing austere prehospital ultrasound into specialist practice.

11:05 – Reaching the MSc Thesis: Rob's progress through the programme.

11:36 – Researching Cognitive Load in Austere Conditions: Identifying a gap in conventional critical care paramedic training.

13:32 – Designing the Research: Comparing conventional scenarios with scenarios incorporating austere stressors.

15:02 – From Dreading Research to Enjoying It: Becoming a first-time clinical researcher.

16:01 – Research Ethics: The challenges of preparing an ethics submission.

17:42 – Why an MSc Should Include Research: Thesis versus coursework and what it means to earn a Master of Science.

19:42 – What Comes After the MSc?: PhDs, lifelong education and knowing when to give the family a break.

20:32 – Taking a Maltese MSc Back to Canada: Recognition, professional development and teaching opportunities.

22:31 – How Canadian Paramedicine Works: PCP, ACP and Critical Care Paramedic pathways.

24:43 – Moving Between Canadian Provinces: Reciprocity and employment across provincial systems.

25:40 – Is There a Canadian Paramedic Registry?: How Ontario regulates and identifies paramedics.

26:59 – International Paramedics Coming to Ontario: Where UK, Australian, South African and other clinicians may fit.

28:09 – Comparing US and Canadian Paramedic Education: Training pathways and entry into critical care practice.

30:06 – Becoming a Critical Care Paramedic in Ontario: The 16–18-month training process and clinical placements.

31:17 – “It's Never Too Late”: Rob became a critical care paramedic in his fifties.

32:04 – What Would Rob Do Differently?: Looking back on the MSc and a 36-year career.

32:54 – Advice for the Next Generation: Learn, experience, enjoy your work and value the people around you.

33:53 – Coming Home to Malta: Pastizzi, cannoli and plans to finally meet in person.

In this episode of the CoROM Podcast, Aebhric O'Kelly speaks with Kevin Fox, a Belgian EMT, maritime security professional and recent graduate of CoROM's BSc in Remote Paramedic Practice.

Kevin's journey into medicine began following the 2016 Brussels terrorist attacks. Working in security at the time, he realised he lacked the medical knowledge to help casualties in a similar emergency. That experience eventually led him through tactical medical training, Belgian EMT education and CoROM's three-year degree.

Kevin discusses his clinical placements in South Africa and Suriname, where he gained experience managing polytrauma, paediatric emergencies, childbirth and tropical infectious diseases. He describes how resource limitations challenged him to improvise, adapt and develop clinical judgement while working alongside local medical teams.

The conversation then turns to tropical medicine in Europe. Kevin shares two memorable ambulance cases involving patients returning from India and Italy, explaining how a detailed travel history helped him recognise possible malaria and dengue. These experiences inspired his proposed research into incorporating recent travel more explicitly into prehospital patient assessment.

Kevin also discusses his dissertation on Belgium's dengue preparedness, the importance of community education and his plans for further research and postgraduate study.

Finally, he reflects on his three years at CoROM, the value of supervised clinical placements and the importance of recognising one's limitations. His advice to clinicians entering remote medicine is simple: test your equipment, remain self-critical and never become a toxic leader.

00:00 – Introducing Kevin Fox: From maritime security to remote paramedicine.

01:04 – The Brussels Terrorist Attacks: The event that inspired Kevin to pursue medical training.

03:05 – Why a Bachelor's Degree?: Professional development and European academic recognition.

04:30 – Future Academic Ambitions: Tropical medicine and postgraduate opportunities.

06:34 – Clinical Placements in Suriname: How TTEMS prepared Kevin for remote clinical practice.

08:35 – Why Suriname?: Language, culture and healthcare challenges.

10:30 – Working in a Surinamese Emergency Department: Trauma assessment and growing clinical responsibility.

13:12 – Memorable Clinical Cases: Polytrauma, paediatric emergencies and delivering a baby.

14:54 – Tropical Diseases in Suriname: Dengue, chikungunya and patients presenting with sepsis.

16:51 – Knowing Your Limitations: Clinical supervision, teamwork and asking for help.

20:10 – Three Years at CoROM: Practical training, student experiences and suggestions for improvement.

23:11 – Advice for First-Year Students: Why anatomy and physiology matter later in clinical practice.

25:28 – Kevin's Dissertation: Dengue preparedness and the establishment of tiger mosquitoes in Belgium.

28:44 – The Importance of Travel History: Recognising malaria in a patient returning from India.

30:00 – Could It Be Dengue?: A patient returning from Italy challenges clinical assumptions.

32:01 – The SAMPLER Research Project: Investigating tropical fever recognition among Belgian ambulance personnel.

33:48 – Tropical Medicine in Europe: Why clinicians need to consider emerging and imported infections.

35:19 – UK Paramedic Registration: Kevin's professional plans after graduation.

36:05 – Maritime and Offshore Medicine: Combining paramedicine with maritime security.

37:05 – Continuing Education: Tropical medicine, clinical laboratory skills and professional networks.

39:02 – Advice for Austere Clinicians: Never assume, remain self-critical and avoid toxic leadership.

40:25 – Closing Remarks.

Chapters

In this episode of CoROM Conversations, Bill Vasios is joined by Dr Bob Dichiera, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University's PA programme.

Bob introduces a practical approach to remote orthopaedics built around four questions: Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation?

The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated pulse, motor and sensory (PMS) assessment before and after interventions.

Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise.

The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments.

00:00 – Tuning-fork fracture diagnosis cold open

00:18 – Introduction to Remote Orthopaedics

01:58 – Why MSK injuries matter in remote medicine

03:00 – Orthopaedic emergencies you cannot miss

04:18 – Damage-control orthopaedics

05:00 – Is the patient dying? Is the limb dying?

06:42 – Closed tibial fractures

07:40 – Diagnosing fractures with a tuning fork

09:06 – Splinting and traction decisions

11:31 – Compartment syndrome

14:00 – Pain with passive stretch

15:30 – Open fractures

16:20 – Irrigation

17:00 – Antibiotics for open fractures

21:06 – Field splinting and improvised splints

23:30 – Shoulder dislocations

25:55 – Shoulder reduction techniques

28:21 – Immobilisation and rehabilitation

30:45 – When should remote clinicians reduce a dislocation?

33:07 – PMS and neurovascular assessment

34:00 – Knee dislocations

35:35 – The easily missed vascular injury

37:56 – Reduction, ABI and evacuation

38:45 – Ankle injuries and Ottawa Ankle Rules

40:20 – Why weight-bearing does not exclude fracture

42:00 – Hand and wrist injuries

42:43 – Pelvic fractures

44:00 – Pelvic binders and avoiding repeated pelvic assessment

45:30 – Haemorrhage and pelvic trauma

46:00 – Pelvis versus femoral neck fracture

47:30 – Ultrasound in remote orthopaedics

47:50 – Should remote clinicians perform fasciotomies?

48:30 – Telemedicine and remote procedural guidance

49:53 – Closing

This week, Aebhric O'Kelly speaks with Dr Travis Kaufman and they explore his 25-year US Army career, his transition from combat engineer and military diver to Physician Assistant (PA), and five years providing medical support through the White House Medical Unit.

Travis describes one of the most difficult lessons emerging from Ukraine: prolonged tourniquet use. A Ukrainian medic explains the decision as “triage of the limb or the life” when attempting tourniquet conversion after several hours may place the casualty at considerable risk.

The discussion examines unnecessary tourniquet use, the importance of reassessment, contaminated wounds and the increasing problem of sepsis when evacuation is delayed for hours or days. Travis argues that the traditional TCCC assumption of rapid evacuation can create a training scar when casualties instead remain with combat lifesavers and medics for prolonged periods.

The episode then explores what PCC actually looks like in practice: trending observations, wound debridement, antimicrobial planning, pain management, positioning, pulmonary care and the fundamental nursing interventions that can determine whether a casualty deteriorates.

Travis also shares examples of improvisation from the field, including improvised PEEP and wound-vacuum techniques, and discusses why clinicians need to rediscover simple solutions when sophisticated equipment is unavailable.

Chapters

00:00 – Meet Dr Travis Kaufman: From Army diver to PA, White House medicine and Ukraine.

02:26 – Becoming a Military Deep-Sea Diver: Training, attrition and operational diving.

06:12 – From Diver to Physician Assistant: Changing careers and entering military medicine.

07:15 – What Is a Physician Assistant?: Origins, training and the military PA role.

10:38 – PA vs Nurse Practitioner: Different educational and clinical models.

13:06 – Advising Across Eastern Europe: Building capability and interoperability.

14:19 – Inside the White House Medical Unit: Medical support for the President and First Family.

15:35 – Medical Planning for the President: Preparing for presidential travel worldwide.

17:32 – Training for High-Consequence Medicine: Trauma preparation and live-tissue training.

19:43 – Humanitarian Medicine in Tanzania: Wilderness medicine and community healthcare.

21:00 – Schistosomiasis and Sickle-Cell Care: Managing disease in resource-limited communities.

24:40 – HIV and the Problem of Follow-Up: When treatment exists but access remains difficult.

27:07 – Inside a Ukrainian Stabilisation Point: Damage-control resuscitation with limited resources.

28:45 – The Limb or the Life: The realities of prolonged tourniquet use.

30:00 – Preventing Unnecessary Limb Loss: Tourniquet reassessment and conversion.

31:56 – Sepsis in Prolonged Casualty Care: The consequences of delayed evacuation.

33:30 – Debridement Without Water: Managing contaminated battlefield wounds.

34:47 – Airways with Limited Equipment: Facial trauma and conserving resources.

36:14 – Taking PCC to the CLS and CMC: Moving prolonged-care skills further forward.

39:09 – What Should a Two-Day PCC Course Teach?: Reassessment, wounds and prolonged-care thinking.

40:45 – Stop Taking Snapshots — Start Trending: Following physiology over time.

42:13 – The “Boring” Care That Saves Lives: Nursing care, positioning, pain and pulmonary management.

43:40 – Improvised PEEP and Wound VACs: Field-expedient solutions when equipment runs out.

45:13 – Rediscovering Old Lessons: What previous wars may teach modern austere medicine.

46:27 – Medicine in the Mediterranean: Travis previews his keynote presentation.

47:45 – “Sir, Are We Gonna Be Okay?”: Trust, responsibility and caring for severely wounded soldiers.

49:49 – Advice for the Austere Clinician: Lose the ego, stay curious and learn from experience.

This week, Aebhric O'Kelly is joined by David Page, a paramedic with more than 40 years of experience spanning frontline EMS, education, accreditation and research. David directs the Prehospital Care Research Forum at UCLA and is closely involved with the International Paramedic Registry (IPR).

The conversation explores the enormous variation in paramedic education and practice around the world. David discusses his work with training centres in more than 20 countries and explains why sophisticated simulation facilities are not necessarily required to deliver excellent education.

Chapters

00:00 – Meet David Page: 40 years of paramedicine, research and education.

01:45 – Assessing EMS Education Around the World: Lessons from training centres in 23 countries.

04:30 – Simulation Without the Million-Dollar Lab: Creating effective training with limited resources.

05:20 – What Is the International Paramedic Registry?: Establishing international standards for paramedicine.

08:01 – Learning from the US National Registry: Why independent certification matters.

10:28 – Defining Levels of Paramedicine: Responder, basic and advanced practice.

13:03 – What Should Every Paramedic Know?: Building and validating 1,028 international competencies.

17:32 – Is IPR Becoming an International Standard?: Adoption, recognition and international mobility.

19:44 – Certification vs Licensure: An important distinction for international paramedics.

21:47 – Degree vs Certification: Does graduating from university prove clinical competency?

26:47 – Does a Degree Guarantee Competence?: Why David argues for independent verification.

28:20 – US vs UK Paramedics: Who Is Better?: Why minimum standards matter more than comparison.

29:17 – When the Same Job Title Means Different Skills: Comparing paramedic education and scope internationally.

30:35 – Does Programme Length Matter?: Why three years of education can mean very different things.

33:40 – Australia's Nurse–Paramedic Model: Different professions and different clinical environments.

36:43 – The UK Paramedic Model: Degrees, registration and the changing ambulance workforce.

39:36 – Germany, Spain and European EMS: Different routes to prehospital practice.

41:50 – Does France Have Paramedics?: Looking beyond professional labels.

44:12 – Can Nurses Take the IPR Exam?: Why hospital expertise does not automatically equal prehospital expertise.

44:52 – Paramedicine Is a Specialty: A separate environment requires a separate body of knowledge.

45:25 – Research, Education and Clinical Practice: David's three-legged stool of paramedicine.

46:56 – “Soak It Up, Buttercup”: David's advice for the next generation.

47:38 – The Privilege of Being a Paramedic: Human dignity, patients and why the work matters.

This week, Aebhric O'Kelly is joined by Jason Jarvis, a former US Army Special Forces medic, tropical medicine educator, and researcher, for a practical discussion of malaria management in remote and resource-limited environments.

Jason reviews the malaria parasite life cycle and explains why understanding the liver and blood stages is important when selecting treatment. The discussion covers current management with artemether–lumefantrine (Coartem) for uncomplicated malaria and IV artesunate for severe disease.

Prevention remains essential. Jason discusses bed nets, repellents and chemoprophylaxis, including Malarone, doxycycline and mefloquine, along with the advantages and adverse effects of each.

The centrepiece of the episode is cabamiquine–pyronaridine. Jason discusses the recent Phase 2a research and two particularly exciting possibilities: single-dose treatment and potential activity against multiple stages of the malaria parasite. If subsequent trials support these findings, this could significantly simplify malaria treatment, particularly in remote settings where adherence to multi-dose regimens can be difficult. Jason also emphasises that cabamiquine remains investigational and requires further clinical evaluation.

The conversation also explores antimalarial resistance, G6PD considerations, R21 and RTS,S malaria vaccines, and the importance of antimicrobial stewardship.

Finally, Jason brings the discussion back to the remote medic: prevent mosquito bites, ensure chemoprophylaxis is taken, carry appropriate contingency treatment and have a realistic diagnostic plan. The episode closes with a discussion of microscopy, malaria rapid diagnostic tests (RDTs), and clinical diagnosis when neither is available.

00:00 – Jason Jarvis Returns: Tropical medicine and infectious-disease education.

02:00 – What Is Malaria?: Understanding the parasite.

04:30 – The Malaria Life Cycle: Mosquito, liver and blood stages.

07:00 – Treating Malaria Today: Current antimalarial therapy.

08:10 – Coartem or IV Artesunate?: Uncomplicated versus severe malaria.

09:15 – Preventing Malaria: Bed nets, repellents and mosquito avoidance.

10:00 – Chemoprophylaxis: Malarone, doxycycline and mefloquine.

11:15 – The Remote Medic's Malaria Kit: Prevention and contingency treatment.

13:30 – Mefloquine and the Nightmares: Benefits and neuropsychiatric effects.

16:15 – Introducing Cabamiquine: A potential new antimalarial.

17:30 – The Phase 2a Trial: Early clinical evidence.

20:30 – Could One Dose Treat Malaria?: The potential for single-dose treatment.

21:15 – The Resistance Problem: Protecting new antimalarials.

22:15 – Why One Dose Matters: Potential benefits in remote settings.

23:00 – Targeting Multiple Parasite Stages: Potential liver and blood-stage activity.

24:00 – Cabamiquine and Primaquine: Implications for liver-stage treatment.

25:30 – What About G6PD?: An important unanswered question.

26:15 – The Future of Malaria Treatment: Could treatment become considerably simpler?

27:10 – Malaria Vaccines: R21 and RTS,S.

28:40 – Antimalarial Resistance: Lessons from Southeast Asia.

30:00 – Advice for the Remote Medic: Practical preparation for malaria.

32:30 – Diagnosing Malaria in the Field: Microscopy and diagnostic planning.

34:15 – Choosing a Malaria RDT: HRP2 and pLDH testing.

35:30 – No RDT, No Microscope: Clinical diagnosis and presumptive treatment.

37:00 – Final Thoughts: Key lessons for austere clinicians.

This week, Aebhric O'Kelly speaks with Christoffer Mäkitalo, a Swedish ambulance and anaesthesia nurse whose career spans remote prehospital care, the Swedish Civil Defence and Resilience Agency, military medicine and repeated training deployments to Ukraine.

For Christoffer, prolonged care is not an unusual operational scenario. After 20 years working in northern Sweden, long response and transport times are part of routine ambulance practice. A call may involve a 45–60-minute response, followed by several hours of transport to a hospital capable of providing the required definitive care. With limited ambulance and helicopter resources covering enormous distances, clinicians must continually balance clinical need, transport decisions and system availability.

The conversation then moves to Ukraine, where Christoffer has worked alongside Tactical Medicine North to support the development of TCCC, Combat Lifesaver, Combat Medic/Corpsman, instructor, blood resuscitation and ultrasound training. His next deployment will include piloting a two-day prolonged field care programme aimed at the CLS level.

A central theme is that the changing battlefield requires prolonged casualty care skills to move further forward. Casualties may remain with combat lifesavers and medics for extended periods, making seemingly basic nursing interventions, keeping patients clean, dry and warm, managing elimination, monitoring wounds and preventing complications, increasingly important. As Christoffer puts it, many combat lifesavers had no healthcare background before the war; skills clinicians consider obvious must therefore be deliberately taught.

Chapters

00:00 – Introduction: Christoffer Mäkitalo

Twenty years of prehospital medicine, military nursing and civil defence work in northern Sweden.

01:41 – When Prolonged Care Is Just Normal Care

Why one-hour-plus evacuation timelines are an everyday reality for ambulance clinicians in northern Sweden.

03:44 – Medical Training in Ukraine

Christoffer's repeated deployments and the evolution from basic TCCC towards instructor development, blood resuscitation and ultrasound.

06:20 – Taking Prolonged Casualty Care to the CLS

Piloting a two-day prolonged field care programme and why these skills need to move beyond highly trained medical personnel.

09:16 – Nursing Skills on the Modern Battlefield

Wound care, hygiene, keeping casualties dry and warm, elimination and other fundamental care when evacuation is delayed.

11:34 – The Battlefield Has Changed

Why assumptions based on rapid evacuation and air superiority no longer reflect the realities being reported from Ukraine.

12:56 – Sweden's Civil Defence and Resilience Agency

Humanitarian operations, international deployments and supporting UN and EU missions around the world.

17:12 – Working as a Swedish Combat Nurse

Combining civilian clinical practice with military medicine

19:49 – Remote Ambulance Medicine in Northern Sweden

Working with limited resources, long distances and the need to become an effective clinical problem-solver.

23:28 – When HEMS Is Not Available

Deciding when to request helicopter support and the operational challenges of weather, icing and enormous geographical coverage.

26:23 – Cross-Border Rescue and Evacuation

Cooperation with Norwegian and Finnish services and the capabilities available across Scandinavia.

27:28 – The Swedish Ambulance Nurse

Education, scope of practice, anaesthesia training and differences between civilian and military clinical capabilities.

30:36 – Treat, Release or Transport?

Why does transporting every patient simply not work when one ambulance journey can take six to eight hours?

33:26 – Fixed-Wing Evacuation

Moving patients over long distances for specialist and critical care unavailable locally.

35:14 – Advice for the New Austere Clinician

Curiosity, humility, lifelong learning and finding the area of medicine that genuinely matters to you.

Aebhric O'Kelly is joined by Dr Csaba Dioszeghy, CoROM co-founder and CEO, critical care and emergency medicine consultant, cardiologist, and experienced prehospital clinician.

The conversation explores what makes education for remote and austere clinicians fundamentally different from conventional medical education. CoROM students work across the world in military, humanitarian, offshore and other resource-limited environments. Csaba discusses why education needs to adapt to these clinicians rather than expecting their professional lives to conform to a traditional university model.

A major theme is listening to students. Aebhric and Csaba discuss how student feedback has directly influenced CoROM's curriculum, facilities, administration and teaching methods — including significant changes being introduced for the new academic year.

They also discuss the redevelopment of the MSc in Austere Critical Care, including more interactive online learning, greater flexibility for students who cannot travel to Malta, and expanded opportunities for practical education. The discussion considers an important question for modern medical education: how much of postgraduate austere medicine can genuinely be taught online, and what still requires hands-on experience?

Chapters

00:00 – Welcome to Season 5

A new academic year, a new podcast season and the changing face of CoROM.

00:38 – CoROM's Next Chapter

Csaba's role as CEO, consolidating a decade of growth and the College's ambitions for the future.

03:02 – What Makes CoROM Different?

Building flexible education for clinicians working across military, humanitarian, offshore and resource-limited environments.

06:52 – Listening to Our Students

How student feedback directly influences curriculum, facilities and the way CoROM teaches.

09:23 – Changing the Practical Curriculum

Revamping classroom education, investing in facilities and placing greater emphasis on hands-on learning.

11:34 – Rebuilding the MSc in Austere Critical Care

New modules, interactive education and moving beyond traditional recorded online lectures.

13:07 – Can You Teach Austere Critical Care Online?

Accessibility, international students and why the redesigned MSc can now be completed without compulsory travel to Malta.

18:01 – Improving Support for Online Students

Human faculty support, central administration and improving communication with students.

19:54 – Building a Better Student Information System

Modernising the administrative infrastructure behind a growing international College.

21:02 – Building the CoROM Community

The future of CoROM's membership structure and strengthening the wider professional community.

23:05 – The CoROM Digital Library

Building offline access to field guides, publications and educational resources.

25:41 – A New Digital and Physical CoROM

New content, facilities, Moodle, equipment and the systems being developed for the new academic year.

28:05 – Quality Assurance and the Future of CoROM

Institutional review, reaccreditation and the longer-term direction of the College.

29:33 – More Hands-On, Less PowerPoint

Updating the BSc and MSc programmes and increasing practical learning when students come to Malta.

32:17 – International Partnerships

Growing educational, clinical and research relationships around the world.

34:02 – Advice for the New Austere Medic

What should a doctor, nurse or medic entering austere medicine concentrate on?

35:00 – When Guidelines Don't Fit the Environment

Why guidelines developed in well-resourced healthcare systems may not always translate directly into resource-limited care.

36:02 – Your Brain Is Still a Resource

Understanding physiology, thinking beyond protocols, innovation and Csaba's final advice: be brave and don't give up.

This week, Aebhric O'Kelly is joined by Professor Mark Hannaford, founder and CEO of World Extreme Medicine, to discuss the evolution of expedition medicine, humanitarian response, and the growing importance of prolonged casualty care in modern conflict.

From kayaking in Patagonia and Antarctica to developing one of the world's leading extreme medicine organisations, Professor Hannaford shares the experiences that shaped his career and explains how World Extreme Medicine has become a global leader in expedition medicine education, research and humanitarian training.

About the Speaker

Professor Mark Hannaford is the Founder and CEO of World Extreme Medicine (WEM), an organisation dedicated to advancing healthcare in remote, austere and expeditionary environments.

Topics Covered

• Professor Hannaford's journey into expedition and extreme medicine
• The origins and philosophy of World Extreme Medicine
• Why expedition medicine is about far more than trauma care
• The importance of primary care in remote environments
• Developing multidisciplinary expedition medical teams
• Breaking down barriers between military, humanitarian and civilian medicine
• Lessons learned from humanitarian work in Ukraine
• Training civilians in Stop the Bleed and emergency trauma care
• The growing importance of Prolonged Casualty Care in modern warfare
• How drone warfare is changing casualty evacuation
• Creating the MSc in Extreme Medicine at the University of Exeter
• Why research is essential for advancing austere medicine
• Advice for clinicians interested in expedition medicine
• The importance of mastering the basics before deploying
• Building experience through events, rescue organisations and outdoor medicine
• The future of extreme medicine and global medical education

Chapters

00:00 – Introduction

Introducing Professor Mark Hannaford

Correct pronunciation and welcome

00:36 – Mark's background

From geographer to expedition leader

Living in Abu Dhabi

A lifetime in expedition and remote medicine

02:02 – Supporting Ukraine

The origins of the World Extreme Medicine Fund

Choosing a focused humanitarian mission

Current work in Ukraine

04:43 – Adventures in British Columbia

Kayaking with orcas

Patagonia expeditions

Antarctica and the Arctic

Wildlife and expedition life

09:56 – How World Extreme Medicine began

Early expedition medicine

Standardising expedition medical support

Paying expedition medics

Building multidisciplinary teams

15:04 – Breaking down medical silos

Why WEM became World Extreme Medicine

Bringing together military, humanitarian, wilderness and expedition medicine

The evolution of the WEM Conference

17:47 – Medicine beyond medicine

Expedition skills

Bushcraft

Vehicle safety

Risk management

19:17 – Primary care versus trauma

The reality of expedition medicine

Why prevention matters

20:29 – The WEM Fund in Ukraine

Medical supply convoys

TCCC and Stop the Bleed

Training civilians

Building local capability

27:44 – Prolonged Casualty Care

Changing battlefield realities

Drone warfare

Extended evacuation times

Adapting PCC education to frontline needs

30:03 – Sharing Ukraine's lessons

Teaching civilians

NATO exercises

Disseminating battlefield medical lessons

32:27 – Creating the MSc in Extreme Medicine

Partnership with the University of Exeter

Professionalising expedition medicine

Research priorities

Translating austere medicine into mainstream healthcare

37:59 – Advice for new expedition medics

Master the basics

Know your limits

Gain domestic experience

Find mentors

Say yes to opportunities

40:36 – Final advice

Prepare for your environment

Listen more than you speak

41:22 – Closing remarks

Reflections on Professor Hannaford's contribution

Final thoughts and thanks

In this episode of CoROM Conversations, Aebhric O'Kelly is joined by Dr Bill Vasios to discuss one of the most overlooked aspects of remote and austere medicine: the intelligent use of over-the-counter (OTC) medications in austere primary care.

Rather than focusing on advanced equipment and prescription drugs, this discussion explores how a carefully selected collection of inexpensive, widely available medications can effectively manage many of the illnesses and injuries encountered in remote, expeditionary, humanitarian and disaster settings.

The conversation emphasises clinical reasoning, careful assessment, conservative prescribing, and making the most of simple interventions before escalating treatment.

Chapters

00:00 – Introduction: Why OTC medicines matter in austere medicine

02:22 – Traveller's diarrhoea

• Assessment
• Oral rehydration
• Loperamide: when to use it (and when not to)

06:54 – Upper respiratory infections

• Symptom management
• Salt-water gargles
• Saline sprays
• When antibiotics are unnecessary

13:34 – Musculoskeletal injuries

• Pain packs
• Diclofenac
• Patient-guided pain management
• RICE and the ice debate

20:45 – Allergic rashes and contact dermatitis

• Hydrocortisone
• Antihistamines
• Oatmeal
• Recognising anaphylaxis

23:02 – Insect bites and stings

• Local treatment
• Cold therapy
• When to escalate care

25:21 – Dehydration

• Oral rehydration
• IV versus oral fluids
• Hydration strategies in the field

29:59 – Heat illness

• Cooling methods
• Field management
• Preventing heat injury

32:15 – Acid reflux in austere environments

• Antacids
• Ginger
• Practical management tips

32:15 – Minor wound care

• Irrigation
• Soap versus antiseptics
• Dakin's solution
• Alcohol and iodine
• Practical wound cleaning

36:45 – Building the ideal austere OTC medical kit

• Essential medications
• Dressings
• Tape
• Water purification
• Splints
• EpiPens
• Multi-use equipment

41:20 – Final discussion, audience questions and wrap-up

The discussion concludes by assembling a practical remote medicine kit, including:

• Oral Rehydration Salts (ORS)
• Paracetamol
• Ibuprofen
• Loperamide
• Antacids
• Oral antihistamines
• Hydrocortisone cream
• Antifungal cream
• Topical diclofenac
• Zinc oxide tape
• Cohesive bandage (Coban/Vet Wrap)
• Saline
• Soap
• Cling film
• Dressings
• Gauze
• Sunscreen
• Water purification equipment
• SAM splints
• EpiPen
• Compact medication organiser (FOLCA)

Key Take-Home Messages

Good assessment should always precede medication.

Oral hydration remains the cornerstone of treating dehydration.

Many common conditions can be managed safely with inexpensive OTC medications.

Every item carried should ideally have multiple uses.

Patient education and involvement improve outcomes.

Simple treatments, applied correctly, are often more effective than complicated ones.

Featured Speakers

Aebhric O'Kelly: Paramedic, educator and Rector of the College of Remote and Offshore Medicine.

Dr Bill Vasios: Physician Associate, educator and specialist in austere and remote healthcare.

Resources Mentioned

World Health Organization Oral Rehydration Solution (ORS)

Wilderness Medical Society clinical practice guidelines

Joint Trauma System Clinical Practice Guidelines (JTS CPGs)

Bristol Stool Chart

Ottawa Ankle Rules

Listen, Learn, Deploy

Whether you're preparing for an expedition, humanitarian mission, offshore deployment or remote clinic, this episode provides practical, evidence-informed advice on building a lightweight, effective medical kit capable of managing the conditions you are most likely to encounter.

This week, Aebhric is joined by Luca Alfatti, an advanced paramedic and co-founder of the World Extreme Medicine Fund, who shares insights from his global medical missions, including recent work in Ukraine and NATO exercises. Discover how adaptable training and international collaboration are transforming emergency medicine in conflict zones.

Chapters

00:00 Introduction to Luca Alfadi and his background

02:10 Luca's journey from expedition leader to advanced paramedic

05:02 Founding of the World Extreme Medicine Fund

06:57 Medical aid efforts in Ukraine during the war

11:59 Training Ukrainian medics in prolonged casualty care

15:59 Challenges of medical resource limitations in conflict zones

20:09 Adapting training to frontline needs and experience levels

25:06 Participation in NATO Vigorous Warrior exercise

27:59 Lessons learned from NATO exercise on prolonged casualty care

31:59 Upcoming publication in the Journal of Special Operations Medicine

35:03 Psychological and societal impacts of war on healthcare workers

38:01 The importance of international collaboration and relationships

39:06 Advice for new medics entering austere medicine

39:50 Closing remarks and future outlook

Keywords

extreme medicine, Ukraine, prolonged casualty care, NATO exercises, medical training, humanitarian aid, expedition medicine, medical innovation, war zones, emergency response

Key Topics

International medical aid in Ukraine

Prolonged casualty care training

NATO Vigorous Warrior exercise insights

Innovations in casualty extraction and treatment

Adapting medical practices to resource-limited settings

The importance of listening to frontline medics

Psychological impacts of war on healthcare workers

Building international medical collaborations

This week, Aebhric O'Kelly speaks with David Stanton, a search and rescue paramedic, former Medic One paramedic, wilderness medicine educator, researcher at the University of Nottingham, and humanitarian medical instructor. David discusses why exceptional basic life support remains the foundation of all advanced medical care, explores innovations from Seattle's renowned Medic One system, shares lessons from Ukraine, and explains his research into prolonged casualty care and medical intelligence.

Chapters

00:00 – Introduction and David Stanton's background

01:00 – The Seattle Medic One system explained

03:00 – Why Seattle achieves exceptional cardiac arrest survival

06:30 – Innovation, research and improving patient outcomes

08:20 – Head-up CPR and evolving resuscitation science

10:00 – Good ALS begins with great BLS

13:00 – Building confident and capable EMTs

17:00 – Should every EMT become an Advanced EMT?

20:30 – Teaching maxillofacial trauma management in Ukraine

23:00 – Learning from Ukrainian combat medicine

27:30 – Teaching wilderness medicine at Nottingham

29:20 – Medical intelligence as an intelligence discipline

32:00 – Rethinking prolonged casualty care

35:00 – Constraint as the foundation of prolonged casualty care

38:30 – NATO's Vigorous Warrior exercise

40:20 – Final advice for new austere medical providers

About the Guest

David Stanton is a search and rescue paramedic with nearly two decades of pre-hospital experience. His career includes service within Washington State's Medic One system, international rescue operations, humanitarian medical education, and research at the University of Nottingham. His current work focuses on prolonged casualty care, medical intelligence, wilderness medicine, and improving healthcare delivery in austere and conflict environments.

Keywords

Seattle Medic One, David Stanton, paramedic, EMT, Advanced EMT, CPR, cardiac arrest, BLS, ALS, wilderness medicine, austere medicine, prolonged casualty care, combat medicine, Ukraine, medical intelligence, NATO, Vigorous Warrior, TCCC, JTS, CoROM Podcast

This week, Aebhric is joined by Fred, who has spent almost four and a half years working in military and military-adjacent medicine in Ukraine, primarily on the forward line of troops (FLOT), with additional experience at casualty collection points and stabilisation points. In this episode, he and Aebhric trace how combat casualty care has changed since 2022: evacuation timelines have stretched from minutes to weeks, wounding patterns have shifted as troop formations disperse to avoid drone strikes, and medics on the ground are being asked to deliver prolonged field care (PFC) far beyond their training. The conversation covers current combat wound pack medications, the phase-out of nalbuphine, tramadol's hepatotoxicity risk in dehydrated patients, the training gap between CLS/CMC-qualified providers, and the disease and non-battle injury (DNBI) burden from leptospirosis to Lyme disease to anthrax that frontline medics are managing largely on their own.

Chapters

00:00 – Introduction and guest welcome

01:00 – Four years of medical experience on the Ukrainian front

02:00 – How drone warfare has changed casualty patterns

03:10 – Evolution of TCCC and prolonged evacuation

04:20 – Changes to battlefield medications and analgesia

06:00 – Ketamine, morphine and tramadol in prolonged casualty care

08:00 – The challenge of prolonged pain management

09:15 – Nerve blocks and expanding combat medic skills

10:15 – Closing the knowledge gap for frontline medics

12:00 – Self-directed learning and educational resources

13:15 – Current medical training available in Ukraine

15:00 – Could prolonged casualty care become a formal certification?

16:00 – A day in the life of a frontline combat medic

18:15 – Drone casualty evacuation: promise and limitations

20:00 – What knowledge do combat medics really need?

22:00 – Disease, dehydration and prolonged field medicine

23:20 – Final advice for new austere medical providers

Evolving battlefield medicine. Evacuation that once happened within minutes from positions near the front now can take weeks, driven by pervasive drone surveillance and strike capability. Mass casualty incidents near the front line have become less common as units disperse, changing the injury and casualty flow medics have to plan for.

Training and knowledge gaps. There's a wide spread in provider background — from Ukrainian feldshers (registered-nurse equivalent) to personnel who completed a seven-day CMC course — all filling the same frontline medic role. Nerve blocks beyond digital blocks aren't commonly taught. Fred argues CMC training was never meant to stand alone; it assumes a prior EMT-level foundation that many providers don't have. Training availability is inconsistent and largely filled by NGOs of varying quality, with NAMT/CLS/CMC certification currently the closest thing to a standard.

Evacuation reality on the ground. Getting to a casualty may take hours to days depending on drone "weather windows." Waits of 30–60 days for evacuation are not unheard of. As a result, stabilisation points are increasingly seeing patients who would survive regardless of intervention, rather than the critical mid-triage-category patients medics are most needed for. Ground evacuation drones (UGVs) are seeing real use but only for stable patients, since medics can't manage an airway or maintain a sedated patient during transit; aerial casualty evacuation is currently considered infeasible due to drone threats.

Disease and non-battle injury (DNBI). Fred and Aebhric discuss the need for a Ukraine-specific DNBI framework and better environmental/threat updates reaching medics in the field.

Closing advice. Fred's advice for new medics, nurses, and physicians entering austere medicine: keep learning and keep developing — people are counting on you to do your job well.

This week, Aebhric O’Kelly is joined by Bill Vasios and Rhod Jordan for an interactive discussion on one of the most important and often overlooked areas of remote medicine: Austere Primary Care.

Whilst trauma often dominates training, the reality is that most remote clinicians spend far more time managing diarrhoeal illness, skin infections, musculoskeletal injuries, respiratory complaints, fever, environmental illnesses, and preventative healthcare. The panel discusses the clinical mindset required to work in resource-limited environments, introduces CoROM's CHART patient assessment system, and explores practical approaches to diagnosis when advanced investigations are unavailable.

Whether you work in expedition medicine, offshore healthcare, humanitarian operations, military medicine, or remote primary care, this episode provides practical insights into becoming a more capable austere clinician.

Chapters

00:05 – Welcome to CoROM Conversations

00:17 – Why primary care matters more than trauma in remote medicine

01:10 – Defining austere and resource-limited environments

02:00 – Developing the austere clinical mindset

02:40 – Becoming comfortable with uncertainty and limited resources

04:00 – Building confidence through deliberate practice

05:00 – Wilderness medicine and learning outside the ambulance

07:15 – Resilience and supporting expedition teams

08:00 – Common primary care presentations in austere environments

08:15 – Gastrointestinal illness, dehydration and traveller's diarrhoea

08:45 – Skin disease, wound care and blister management

09:30 – Environmental illness: hypothermia, frostbite and heat injury

10:10 – Musculoskeletal injuries in expedition medicine

11:55 – Learning orthopaedic assessment through repetition

13:00 – ENT, eye and dental emergencies

14:20 – Introducing the CoROM CHART assessment framework

16:40 – Chief Complaint, Condition and the CPRO assessment

17:20 – Recognising the critically ill patient

20:15 – History taking using SAMPLER with additional risk assessment

22:00 – Secondary assessment using the BEAST observations

26:10 – Review of systems using CRANES

27:30 – Treatment, disposition and clinical trending

28:10 – Diagnostic tools for austere medicine

30:30 – Essential point-of-care investigations

31:00 – Why every diagnostic tool needs a backup plan

33:00 – Altitude, pulse oximetry and interpreting observations

34:00 – Fever assessment in austere environments

34:45 – Measuring temperature correctly in older adults and children

35:40 – Managing fever of unknown origin and malaria

36:10 – Nursing care and prolonged patient management

36:45 – Public health and preventative medicine

37:30 – Recognising clinical red flags

38:00 – Key learning points and deployment preparation

39:00 – The importance of clinical examination over technology

40:00 – Trusting your senses and treating the patient—not the monitor

41:00 – Closing remarks and CoROM CPD opportunities

Key Topics Discussed

Austere primary care

Clinical reasoning in resource-limited environments

The austere clinical mindset

Preventative medicine

Travel medicine

Wilderness medicine

Expedition healthcare

Remote diagnostics

Fever of unknown origin

Malaria diagnosis

Environmental medicine

Musculoskeletal injuries

Skin disease

Point-of-care ultrasound

Nursing care in prolonged field care

The CoROM CHART assessment system

CPRO and BEAST observations

Differential diagnosis

Key Takeaways

Most remote clinicians spend considerably more time managing primary care conditions than major trauma.

Clinical confidence develops through experience, deliberate practice and mentorship.

Every piece of diagnostic equipment should have a backup plan.

Careful history taking remains one of the most valuable diagnostic tools available.

Trend observations over time rather than relying on single measurements.

In malaria-endemic regions, malaria should remain high on the differential diagnosis for every patient with fever.

In this special episode of the CoROM Podcast, Dr Winston de Mello joins Aebhric O’Kelly for a wide-ranging discussion on burns, military medicine, medical education, mentorship, and the evolution of austere healthcare.

A founding influence behind CoROM and a former Commanding Officer of the UK military's Battlefield Advanced Trauma Life Support (BATLS) programme, Winston reflects on decades of service, from treating burn casualties after the Falklands War to helping shape generations of military medics, doctors, nurses, and paramedics.

The conversation explores prehospital burn care, topical morphine, ketamine procedural sedation, the origins of several austere medicine assessment techniques still taught today, and the importance of lifelong learning and compassionate patient care.

Chapters

00:05 – Introduction to Dr. Winston DeMello

00:53 – Current work in burn care and pelvic pain medicine

01:17 – The origins of Severe Burn Life Support (SBLS)

02:46 – Burn education at bachelor's and master's level

03:29 – How the Falklands War sparked a lifelong interest in burns

04:50 – Why severe burns remain a chronic disease

06:07 – The importance of burn education in austere medicine

06:55 – The fundamentals of burn management

07:09 – Why cling film remains one of the best burn dressings

08:02 – Infection prevention and moisture control with cling film

08:59 – Teaching burn care internationally

09:29 – The story behind topical morphine for burns

11:11 – Twenty years of experience using topical morphine

11:41 – Why morphine should be diluted with water rather than saline

12:20 – Topical morphine for ulcers, wounds, and joint pain

13:11 – What is a ketamine shower?

14:00 – Burn dressing changes under ketamine procedural sedation

15:28 – Why ketamine remains underutilised in medicine

17:27 – First meeting at the BATLS course

18:59 – Teaching catastrophic haemorrhage during wartime deployments

21:20 – The importance of passion in medical education

24:20 – The multiplier effect of teaching future instructors

25:24 – End-of-life care and battlefield medicine

26:41 – Burns education and the evolution of austere medicine

27:10 – Learning how to teach at BATLS

28:29 – The influence of legendary military instructors

30:36 – Building the BATLS faculty team

31:11 – Teaching others how to teach

32:36 – The origins of CoROM and early wilderness medicine training in Ireland

33:33 – Persistence, resilience, and building educational programmes

34:37 – Mentoring students including Grigory Tisenovich

35:14 – The origins of the "Winston Sign" for estimating CVP

38:24 – The importance of historical medical knowledge

39:18 – The "Palmar Crease Sign" and assessing anaemia

40:46 – Treating the future King of Jordan at Sandhurst

43:26 – How a military patient inspired a career in pelvic pain medicine

45:11 – Meeting Dr. Mallampati and airway management history

47:22 – The story behind the Trendelenburg name

48:29 – Reflections on mentorship and professional legacy

49:25 – Advice for the next generation of austere clinicians

50:49 – "Do the basics well, but always in style"

51:01 – Closing thoughts and future collaboration

Guest Biography

Dr Winston DeMello is an anaesthetist, military medical educator, burns specialist, and one of the founding influences behind the College of Remote and Offshore Medicine Foundation.

He served as Commanding Officer of the UK military's BATLS programme and has held fellowships from all four Royal Colleges. His career has included extensive work in burn care, military medicine, procedural sedation, prehospital care, and pelvic pain medicine. He continues to contribute to international education through Severe Burn Life Support (SBLS) and advanced burn care training.

This week, Aebhric O’Kelly sits down with Dr Ella Corrick, Head of Postgraduate Studies at the College of Remote and Offshore Medicine (CoROM) and Director of the Doctor of Health Studies (DHS) programme. Ella discusses her work as a rural physician in the Scottish Highlands, her role in mountain rescue, and how CoROM is helping clinicians transform operational experience into meaningful doctoral research.

The conversation explores rural medicine, doctoral education, research methodology, healthcare systems in austere environments, and the future of research in remote and resource-limited settings.

Chapters

00:00 Introduction and welcome back to the podcast

00:25 Working as a physician in the Scottish Highlands

01:00 Life after becoming a new parent

01:40 Mountain rescue and rural emergency medicine

02:00 Joining CoROM and taking over the DHS programme

03:00 Shared challenges in rural and austere medicine

04:20 Transforming operational experience into research

06:30 Who are CoROM doctoral students?

08:30 Future directions for doctoral research

11:00 Why CoROM focuses on applied rather than laboratory research

12:30 Understanding the Doctor of Health Studies (DHS)

16:00 How long does a doctorate really take?

17:50 Oxford, Nottingham, and Ella’s research journey

22:00 Research on prescribing quality in children

25:40 How doctoral study improves clinical practice

27:40 DHS versus a traditional PhD

29:20 Advice for prospective doctoral students

32:30 Ella’s current research interests

35:00 Mountain rescue, resilience, and rural healthcare

38:00 Books, science fiction, and lifelong curiosity

40:30 Advice for clinicians entering austere medicine

41:40 Closing thoughts

Topics Discussed

Rural and island medicine

Mountain rescue

Doctoral education

Research methodology

Telemedicine

Resource-limited healthcare

Prolonged casualty care

Clinical leadership

Research literacy

Volunteer emergency services

Healthcare resilience

Evidence-based medicine

This special 200th episode of the CoROM podcast celebrates four years of continuous weekly episodes and reflects on the journey of the College of Remote and Offshore Medicine. Founder Aebhric O’Kelly is joined by fellow founders John Clark and Dr Csaba Dioszeghy to discuss how CoROM began, why Malta was chosen as its home, the growth of the organisation over the past decade, and the vision for the next five years.

The conversation explores CoROM’s evolution from a small training organisation into an internationally recognised higher education institution serving students from more than 30 countries across five continents.

Chapters

00:00 Introduction and celebrating 200 podcast episodes

00:50 How the three founders came together

01:20 Why CoROM moved to Malta

03:40 Malta’s medical history and its connection to CoROM

08:10 Why Pretty Bay became CoROM’s home

10:20 Historical medicine in Malta and the Hospitallers

12:00 Growth of CoROM over the past three years

13:00 Launch of the Doctorate in Health Studies (DHS)

14:00 The impact of the CoROM podcast

15:00 Building a non-profit educational institution

15:50 The origins of Remote Medicine Ireland

20:00 Student growth and global reach

22:40 Medicine in the Mediterranean (MIM) Conference

26:30 The CoROM family culture

28:20 Looking ahead: the next 12 years

28:40 John Clark’s five-year vision

34:00 Dr Csaba Dioszeghy’s five-year vision

38:00 Keeping education affordable

39:00 Impact stories from Tanzania

40:20 CoROM’s mission and global influence

41:40 Reflections on 200 podcast episodes

42:30 Closing remarks

Key Discussion Points

Why Malta?

The founders discuss the circumstances that led CoROM to Malta in 2014. What began as an opportunity to support paramedic education evolved into the establishment of a permanent educational institution. Malta’s strategic location, English-speaking environment, rich medical history, and accessibility for international students all contributed to the decision.

John Clark highlights Malta’s historical identity as the “Hospital of the Mediterranean” and its longstanding connection to military and austere medicine traditions.

Building CoROM

Aebhric reflects on the origins of Remote Medicine Ireland and how frustration with expensive, poor-quality educational programmes motivated the creation of something different. The founders describe the progression from wilderness medicine courses to paramedic education, postgraduate programmes, and doctoral-level education.

Global Reach

CoROM currently serves more than 160 students from over 30 countries across five continents. The founders discuss the importance of maintaining a truly international perspective while preserving a close-knit educational culture.

Medicine in the Mediterranean (MIM27)

The founders discuss the rapid growth of the Medicine in the Mediterranean conference, which has become a recognised gathering point for practitioners interested in remote, austere, wilderness, expedition, military, and offshore medicine.