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CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.: Daily Summaries Delivered
by College of Remote and Offshore Medicine
Hosted by Aebhric O'Kelly, a critical care paramedic and former Green Beret, CoROM Cast explores wilderness medicine, austere healthcare, tropical diseases, emergency medicine, and remote medical practice. Weekly discussions feature global experts on Prolonged Field Care, Austere Critical Care, disaster medicine, humanitarian response, military pre-hospital care, tropical medicine, expedition healthcare, medical innovation, and practical solutions for healthcare in resource-limited environments. Published by CoROM Press www.corom.edu.mt
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- Yesterday36 min
206-World Extreme Medicine Fund with Luca Alfatti
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.Chapters00:00 Introduction to Luca Alfadi and his background02:10 Luca's journey from expedition leader to advanced paramedic05:02 Founding of the World Extreme Medicine Fund06:57 Medical aid efforts in Ukraine during the war11:59 Training Ukrainian medics in prolonged casualty care15:59 Challenges of medical resource limitations in conflict zones20:09 Adapting training to frontline needs and experience levels25:06 Participation in NATO Vigorous Warrior exercise27:59 Lessons learned from NATO exercise on prolonged casualty care31:59 Upcoming publication in the Journal of Special Operations Medicine35:03 Psychological and societal impacts of war on healthcare workers38:01 The importance of international collaboration and relationships39:06 Advice for new medics entering austere medicine39:50 Closing remarks and future outlookKeywordsextreme medicine, Ukraine, prolonged casualty care, NATO exercises, medical training, humanitarian aid, expedition medicine, medical innovation, war zones, emergency responseKey TopicsInternational medical aid in UkraineProlonged casualty care trainingNATO Vigorous Warrior exercise insightsInnovations in casualty extraction and treatmentAdapting medical practices to resource-limited settingsThe importance of listening to frontline medicsPsychological impacts of war on healthcare workersBuilding international medical collaborations
- 1 weeks ago33 min
205-Good ALS starts with great BLS with David Stanton
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.Chapters00:00 – Introduction and David Stanton's background01:00 – The Seattle Medic One system explained03:00 – Why Seattle achieves exceptional cardiac arrest survival06:30 – Innovation, research and improving patient outcomes08:20 – Head-up CPR and evolving resuscitation science10:00 – Good ALS begins with great BLS13:00 – Building confident and capable EMTs17:00 – Should every EMT become an Advanced EMT?20:30 – Teaching maxillofacial trauma management in Ukraine23:00 – Learning from Ukrainian combat medicine27:30 – Teaching wilderness medicine at Nottingham29:20 – Medical intelligence as an intelligence discipline32:00 – Rethinking prolonged casualty care35:00 – Constraint as the foundation of prolonged casualty care38:30 – NATO's Vigorous Warrior exercise40:20 – Final advice for new austere medical providersAbout the GuestDavid 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.KeywordsSeattle 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
- 2 weeks ago25 min
204-Frontline Medic in Ukraine
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.Chapters00:00 – Introduction and guest welcome01:00 – Four years of medical experience on the Ukrainian front02:00 – How drone warfare has changed casualty patterns03:10 – Evolution of TCCC and prolonged evacuation04:20 – Changes to battlefield medications and analgesia06:00 – Ketamine, morphine and tramadol in prolonged casualty care08:00 – The challenge of prolonged pain management09:15 – Nerve blocks and expanding combat medic skills10:15 – Closing the knowledge gap for frontline medics12:00 – Self-directed learning and educational resources13:15 – Current medical training available in Ukraine15:00 – Could prolonged casualty care become a formal certification?16:00 – A day in the life of a frontline combat medic18:15 – Drone casualty evacuation: promise and limitations20:00 – What knowledge do combat medics really need?22:00 – Disease, dehydration and prolonged field medicine23:20 – Final advice for new austere medical providersEvolving 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.
- 3 weeks ago41 min
203-Austere Primary Care Webinar
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 Conversations00:17 – Why primary care matters more than trauma in remote medicine01:10 – Defining austere and resource-limited environments02:00 – Developing the austere clinical mindset02:40 – Becoming comfortable with uncertainty and limited resources04:00 – Building confidence through deliberate practice05:00 – Wilderness medicine and learning outside the ambulance07:15 – Resilience and supporting expedition teams08:00 – Common primary care presentations in austere environments08:15 – Gastrointestinal illness, dehydration and traveller's diarrhoea08:45 – Skin disease, wound care and blister management09:30 – Environmental illness: hypothermia, frostbite and heat injury10:10 – Musculoskeletal injuries in expedition medicine11:55 – Learning orthopaedic assessment through repetition13:00 – ENT, eye and dental emergencies14:20 – Introducing the CoROM CHART assessment framework16:40 – Chief Complaint, Condition and the CPRO assessment17:20 – Recognising the critically ill patient20:15 – History taking using SAMPLER with additional risk assessment22:00 – Secondary assessment using the BEAST observations26:10 – Review of systems using CRANES27:30 – Treatment, disposition and clinical trending28:10 – Diagnostic tools for austere medicine30:30 – Essential point-of-care investigations31:00 – Why every diagnostic tool needs a backup plan33:00 – Altitude, pulse oximetry and interpreting observations34:00 – Fever assessment in austere environments34:45 – Measuring temperature correctly in older adults and children35:40 – Managing fever of unknown origin and malaria36:10 – Nursing care and prolonged patient management36:45 – Public health and preventative medicine37:30 – Recognising clinical red flags38:00 – Key learning points and deployment preparation39:00 – The importance of clinical examination over technology40:00 – Trusting your senses and treating the patient—not the monitor41:00 – Closing remarks and CoROM CPD opportunitiesKey Topics DiscussedAustere primary careClinical reasoning in resource-limited environmentsThe austere clinical mindsetPreventative medicineTravel medicineWilderness medicineExpedition healthcareRemote diagnosticsFever of unknown originMalaria diagnosisEnvironmental medicineMusculoskeletal injuriesSkin diseasePoint-of-care ultrasoundNursing care in prolonged field careThe CoROM CHART assessment systemCPRO and BEAST observationsDifferential diagnosisKey TakeawaysMost 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.
- 4 weeks ago44 min
202-A Life in Medicine with Dr Winston de Mello
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.Chapters00:05 – Introduction to Dr. Winston DeMello00:53 – Current work in burn care and pelvic pain medicine01:17 – The origins of Severe Burn Life Support (SBLS)02:46 – Burn education at bachelor's and master's level03:29 – How the Falklands War sparked a lifelong interest in burns04:50 – Why severe burns remain a chronic disease06:07 – The importance of burn education in austere medicine06:55 – The fundamentals of burn management07:09 – Why cling film remains one of the best burn dressings08:02 – Infection prevention and moisture control with cling film08:59 – Teaching burn care internationally09:29 – The story behind topical morphine for burns11:11 – Twenty years of experience using topical morphine11:41 – Why morphine should be diluted with water rather than saline12:20 – Topical morphine for ulcers, wounds, and joint pain13:11 – What is a ketamine shower?14:00 – Burn dressing changes under ketamine procedural sedation15:28 – Why ketamine remains underutilised in medicine17:27 – First meeting at the BATLS course18:59 – Teaching catastrophic haemorrhage during wartime deployments21:20 – The importance of passion in medical education24:20 – The multiplier effect of teaching future instructors25:24 – End-of-life care and battlefield medicine26:41 – Burns education and the evolution of austere medicine27:10 – Learning how to teach at BATLS28:29 – The influence of legendary military instructors30:36 – Building the BATLS faculty team31:11 – Teaching others how to teach32:36 – The origins of CoROM and early wilderness medicine training in Ireland33:33 – Persistence, resilience, and building educational programmes34:37 – Mentoring students including Grigory Tisenovich35:14 – The origins of the "Winston Sign" for estimating CVP38:24 – The importance of historical medical knowledge39:18 – The "Palmar Crease Sign" and assessing anaemia40:46 – Treating the future King of Jordan at Sandhurst43:26 – How a military patient inspired a career in pelvic pain medicine45:11 – Meeting Dr. Mallampati and airway management history47:22 – The story behind the Trendelenburg name48:29 – Reflections on mentorship and professional legacy49:25 – Advice for the next generation of austere clinicians50:49 – "Do the basics well, but always in style"51:01 – Closing thoughts and future collaborationGuest BiographyDr 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.
- Jun 26, 202639 min
201-Doctorate in Health Studies with Dr Ella Corrick
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.Chapters00:00 Introduction and welcome back to the podcast00:25 Working as a physician in the Scottish Highlands01:00 Life after becoming a new parent01:40 Mountain rescue and rural emergency medicine02:00 Joining CoROM and taking over the DHS programme03:00 Shared challenges in rural and austere medicine04:20 Transforming operational experience into research06:30 Who are CoROM doctoral students?08:30 Future directions for doctoral research11:00 Why CoROM focuses on applied rather than laboratory research12:30 Understanding the Doctor of Health Studies (DHS)16:00 How long does a doctorate really take?17:50 Oxford, Nottingham, and Ella’s research journey22:00 Research on prescribing quality in children25:40 How doctoral study improves clinical practice27:40 DHS versus a traditional PhD29:20 Advice for prospective doctoral students32:30 Ella’s current research interests35:00 Mountain rescue, resilience, and rural healthcare38:00 Books, science fiction, and lifelong curiosity40:30 Advice for clinicians entering austere medicine41:40 Closing thoughtsTopics DiscussedRural and island medicineMountain rescueDoctoral educationResearch methodologyTelemedicineResource-limited healthcareProlonged casualty careClinical leadershipResearch literacyVolunteer emergency servicesHealthcare resilienceEvidence-based medicine
- Jun 19, 202640 min
200-CoROM Founders discuss 10 years of CoROM
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. Chapters00:00 Introduction and celebrating 200 podcast episodes00:50 How the three founders came together01:20 Why CoROM moved to Malta03:40 Malta’s medical history and its connection to CoROM08:10 Why Pretty Bay became CoROM’s home10:20 Historical medicine in Malta and the Hospitallers12:00 Growth of CoROM over the past three years13:00 Launch of the Doctorate in Health Studies (DHS)14:00 The impact of the CoROM podcast15:00 Building a non-profit educational institution15:50 The origins of Remote Medicine Ireland20:00 Student growth and global reach22:40 Medicine in the Mediterranean (MIM) Conference26:30 The CoROM family culture28:20 Looking ahead: the next 12 years28:40 John Clark’s five-year vision34:00 Dr Csaba Dioszeghy’s five-year vision38:00 Keeping education affordable39:00 Impact stories from Tanzania40:20 CoROM’s mission and global influence41:40 Reflections on 200 podcast episodes42:30 Closing remarks Key Discussion PointsWhy 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 CoROMAebhric 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 ReachCoROM 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.
- Jun 12, 202659 min
199-Snake Bites with Dr Evan Baines
This month, CoROM Conversations is joined by Dr Evan Baines, Emergency Medicine Physician, EMS Fellow, former 18D, and contributor to the JTS Snake Envenomation Clinical Practice Guideline (CPG).Snake envenomation remains a major global health problem, with millions of bites occurring annually and a disproportionate burden falling on remote and resource-limited regions. In this episode, Dr Evan Baines discusses the development of the JTS Snake Envenomation CPG, practical field management, antivenom selection, operational planning, and common misconceptions surrounding snakebite treatment.Chapters00:00 – Introduction to Snake Envenomation01:45 – Why Snake Bites Matter in Austere Medicine04:00 – Snakebite Myths and Immediate First Aid05:00 – The Four Envenomation Syndromes08:00 – Operational Planning and Antivenom Selection11:20 – Understanding the JTS Treatment Algorithms16:00 – Case Study: Pit Viper Envenomation22:00 – Determining When Antivenom Has Worked24:00 – Antivenom Dosing Principles26:00 – Field Diagnostics and Coagulopathy Assessment28:00 – Neurotoxic Snake Bites and Respiratory Failure33:00 – Why Identifying the Snake Often Doesn't Matter34:00 – Dry Bites and Return-to-Duty Decisions36:00 – Antivenom Reactions and Anaphylaxis Management39:00 – Tourniquets, Pressure Bandages, and Controversies46:00 – Life Over Limb? Risk-Benefit Decision Making51:00 – Airway Management in Neurotoxic Envenomation55:00 – Regulatory Challenges and Deployment Considerations57:45 – Key Take-Home Messages
About CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.
Hosted by Aebhric O'Kelly, a critical care paramedic and former Green Beret, CoROM Cast explores wilderness medicine, austere healthcare, tropical diseases, emergency medicine, and remote medical practice. Weekly discussions feature global experts on Prolonged Field Care, Austere Critical Care, disaster medicine, humanitarian response, military pre-hospital care, tropical medicine, expedition healthcare, medical innovation, and practical solutions for healthcare in resource-limited environments. Published by CoROM Press www.corom.edu.mt
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