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

This week, Aebhric O'Kelly speaks with three combat medics from Tactical Medicine North following a Tactical APUS instructor development programme in Malta. The discussion explores whether ultrasound can be taught to non-medical personnel operating in combat environments, including Combat Lifesavers (CLS) and Combat Medic Corpsmen (CMC), and how ultrasound may support prolonged casualty care, triage, and telemedicine in Ukraine. The conversation challenges traditional assumptions regarding ultrasound education, introduces the Tactical APUS concept, discusses modifications to the standard eFAST examination sequence, and reviews preliminary observations from a study comparing parasternal long-axis (PLAX) and subxiphoid cardiac views. Chapters00:00 – Introduction01:06 – Can Non-Medics Learn Ultrasound?03:00 – Lessons from the APUS Course05:30 – The Power of Home Points07:50 – What is Tactical APUS?10:00 – Adapting eFAST for Combat Operations12:30 – Hypothermia Prevention During Ultrasound15:20 – The Controversial Change: Heart Last20:00 – PLAX vs Subxiphoid Cardiac Views24:40 – Teaching Maltese Nurses29:10 – Should We Teach Ultrasound to Combat Lifesavers?32:20 – Ultrasound as a Triage Tool35:10 – Advice for Future Tactical Ultrasound Providers38:00 – Closing RemarksKey TakeawaysThe parasternal long-axis cardiac viewappears easier for novice learners than the traditional subxiphoid view.Overview of the APUS and Tactical APUS training programme conducted in Malta. Discussion on teaching eFAST ultrasound to Combat Lifesavers and Combat Medic Corpsmen.Comparison with early challenges teaching combat medicine to personnel without formal medical backgrounds. Importance of simple teaching techniques and instructor adaptability.Introduction of the "Home Point" concept for each eFAST window. How home points help students recover when they become disoriented during scanning.Development of a one-day ultrasoundcurriculum for tactical providers.Focus on eFAST as a trauma tool for prolonged field care and telemedicine support.Discussion of modifying the traditional eFAST sequence.Prioritising lung assessment over cardiac views.The dangers of exposing casualties during scanning.Importance of maintaining casualty insulation and minimising gel exposure.Why the Tactical APUS team moved cardiac assessment after lung assessment.Students consistently finding the parasternal long-axis view easier to obtain.Experience using Maltese nurses as pilot students.Differences between teaching healthcare professionals and non-medical personnel.Language barriers and instructional adaptations. Moving beyond "Can we?" to "Should we?"Ultrasound as a prolonged casualty care and telemedicine tool.Supporting decision-making during extended evacuations. Using eFAST to prioritise casualties during mass casualty situations.Early identification of internal bleedingand pneumothorax.Potential role of optic nerve sheath diameter (ONSD) assessment in blast-related head injuries. Importance of accessibility of handheld ultrasound devices.The role of deliberate practice and repetition in ultrasound mastery. Reflections on the success of the Tactical APUS pilot programme.Future collaboration between CoROM and Tactical Medicine North.Final thoughts from the Ukrainian instructors. Ultrasound can be successfully taught to Combat Lifesavers and Combat Medic Corpsmen when training is focused on pattern recognition and image acquisition rather than advanced interpretation."Home Points" provide a powerful cognitive aid for novice sonographers.Lung ultrasound may provide greater battlefield utility than cardiac ultrasound because interventions can be performed immediately.Hypothermia prevention must remainintegrated into all ultrasound training and operational use.

This week, Aebhric O’Kelly is joined by Antonio from European Medics to discuss his first experience attending the Special Operations Medical Association Symposium, the growing importance of Medical Support to Irregular Warfare (MSIW), and how civilian and military healthcare systems must integrate to prepare for future conflicts and disasters. Antonio reflects on lessons from occupied Poland, resistance medicine, Ukrainian battlefield realities, and the importance of resilience, logistics, telemedicine, and improvised medicine in modern austere healthcare systems. Chapters00:00 Introduction and Antonio’s background01:10 First experience attending SOMA03:10 “People over products” in tactical medicine04:30 Civilian involvement in special operations medicine06:50 Key lessons from the MSIW track09:45 What is Medical Support to Irregular Warfare (MSIW)?11:10 Historical resistance medicine in Poland and the Baltics15:00 Underground clinics and covert evacuation chains17:30 Telemedicine in resistance healthcare18:30 How civilian medics can prepare for MSIW21:00 TCCC, JTS CPGs, and tactical medicine education22:00 European Medics Tactical Clinical Operations (TCO) course23:30 Taiwan, resilience, and whole-of-society defence26:20 Logistics and manufacturing challenges in conflict28:40 Relationship building and NATO interoperability29:10 3D printing and improvised medicine31:20 Antonio’s passion for guerrilla medicine34:00 Future plans: anaesthesia, ICU, and flight medicine35:10 Advice for new medics entering austere medicine37:00 Closing remarksEpisode HighlightsFirst impressions from the SOMA SymposiumWhy “people over products” matters in tactical medicineCivilian-military integration in modern conflictWhat MSIW (Medical Support to Irregular Warfare) actually meansHistorical resistance medicine in Poland and the BalticsLessons from Ukraine and occupied territoriesUnderground clinics and covert casualty evacuationTelemedicine and distributed healthcare networksWhy civilian clinicians should learn TCCCLogistics, supply chains, and local manufacturing during war3D printing and improvised medical equipmentThe future of European resilience medicineAdvice for new medics entering austere medicine

This week, Aebhric O'Kelly is joined by William Krupa, who recently graduated from the MSc Austere Critical Care programme. They discuss wilderness medicine, tactical medicine education, prolonged field care, and his experience completing the MSc in Austere Critical Care at the College of Remote and Offshore Medicine Foundation.William shares his journey from infantry soldier to paramedic educator, discusses teaching Wilderness First Responder (WFR) programmes, reflects on attending the Medicine in the Mediterranean Conference in Malta, and provides an overview of his MSc thesis on austere mechanical ventilation using portable oxygen concentrators and closed-circuit systems.This episode explores how austere medicine education can reinvigorate clinicians, improve critical thinking, and bridge the gap between theory and operational practice. Chapters00:00 – Introduction to the episode and guest welcome00:41 – William’s current work in paramedicine, wilderness medicine, and tactical medicine education01:20 – Military background and transition into medicine02:30 – Repeating EMT training after military service03:53 – Why repeated teaching improves clinicians and educators05:07 – The value of teaching Wilderness First Responder (WFR) courses07:22 – Deep dives into improvised medicine during longer wilderness courses07:55 – The history of CoROM and how WFR led to degree programmes09:33 – William’s first trip to Malta for APUS and ICARE10:20 – Scenario-based learning and hands-on education at CoROM11:34 – The realism of the ICARE moulage and burn simulations14:05 – Medicine in the Mediterranean Conference experience14:51 – Ukraine battlefield medicine workshop and WPC certification15:40 – Graduation and earning the MSc in Austere Critical Care16:14 – Publishing research and future doctoral plans17:18 – Why William chose the MSc in Austere Critical Care19:23 – What makes CoROM different from other critical care programmes22:16 – Mentorship from MD-PhD faculty and practical education26:08 – William’s MSc thesis on austere mechanical ventilation27:39 – Using oxygen concentrators and closed-circuit systems in austere care29:28 – Research discussion: dual oxygen concentrators and FiO₂ optimisation31:15 – Challenges during the MSc programme33:32 – How the MSc changed William’s clinical practice34:44 – Suggestions for future development of the MSc programme36:47 – Teaching WFR in Utah with Black Swan and Human Path39:01 – Achieving Fellowship of the Academy of Wilderness Medicine (FAWM)41:08 – Why wilderness fellowships carry professional value43:46 – Advice for new medics entering austere medicine45:11 – Closing remarks and congratulations Key Topics • Wilderness medicine education • WMS FAWM • Tactical medicine and TC3 instruction • Prolonged Field Care (PFC) • Austere Critical Care education • Scenario-based simulation training • Improvised medicine • Mechanical ventilation in austere environments • Oxygen conservation strategies • Wilderness medicine fellowships • Medical education mentorship • International austere medicine collaboration Key Takeaways• Scenario-based education improves retention and operational performance. • Wilderness medicine often reignites clinicians’ passion for medicine. • Austere medicine requires adaptability rather than dependence on resources. • International collaboration broadens clinical understanding and perspective. • Practical mentorship from operational clinicians is critical in advanced education. • Mechanical ventilation in austere environments may be feasible with low-resource systems. • Long-form wilderness courses allow deeper exploration of improvised medicine concepts. • Continuous learning is essential for clinicians operating in remote and austere environments.

This week, Aebhric O’Kelly is again joined by Zach Andrews, a MSc Austere Critical Care graduate and expert in jungle medicine, who shares his extensive experience in remote critical care, setting up ICUs in challenging environments, and improving medical education. Discover practical tips for medical professionals working in remote areas and learn about innovative approaches to medical training and patient care.Chapters00:00 Introduction and Guest Introduction00:26 Zach Andrews' Background and Current Projects01:06 Role in Student Success Department02:34 Student Program Feedback and Challenges05:50 Faculty and Program Cost-Effectiveness11:27 Setting Up ICUs in Remote and Austere Areas20:42 Importance of Hands-On Assessment in Remote Settings23:00 The Jack of All Trades in Jungle ICU Setup25:18 Lessons from Masters of Austere Care27:33 SOMA Scholarship and Zach's Presentation29:34 Advice for New Medics in Austere Medicine30:52 Closing Remarks and Final Thoughts

This week, Aebhric O’Kelly is joined by Dr Michael Klopper, who recently earned his doctorate from CoROM and shares his journey from South Africa to becoming a doctoral candidate in AI, his extensive experience in remote medicine and mountain rescue, and his views on the future of AI in medical research and education. Discover insights on mountain medicine training, AI's role in healthcare, and practical advice for medical professionals in challenging environments.Chapters00:00 Introduction and Dr Klopper's background01:42 Early connection with the College and initial projects04:06 Setting up clinical placements and courses in South Africa05:44 East London clinical work and EMS programs07:28 Dr Klopper's Wilderness Medicine Fellow (FAWM) and future plans11:48 Dr Klopper's PhD thesis on AI in medicine18:19 The importance of search mechanisms and AI in research21:57 Risks and best practices for AI in academic research24:57 Advice for new medical professionals and outdoor enthusiasts28:48 Preparing for deployment in challenging environments29:30 The role of aviation safety and small details in rescue missions32:16 Closing remarks and future plans for Dr Klopper

This week, Aebhric O’Kelly is joined by Rhod Jordan and Bill Vasios as they discuss how to create an ICU in the jungle. They discuss setting up and managing a remote ICU in jungle environments, focusing on site selection, equipment, logistics, and medical considerations for field medics and responders.Chapters00:00 Introduction and Content Overview00:41 Premise and Scenario Setup for Jungle ICU01:33 Site Selection Criteria in Jungle Environments02:19 Environmental Challenges: Rain, Creepy Crawlies, and Hypothermia03:08 Privacy, Lighting, and Visibility in Remote Settings03:53 Creating a Functional Jungle Clinic Layout04:34 Lighting and Visibility Strategies at Night05:31 Accessibility and Zone Planning in Field Clinics06:09 Assessing Capacity: Multiple Patients and Beds07:01 Monitoring Equipment: Minimum and Advanced Options08:04 Power, Water, and Communication Logistics08:42 Prolonged Casualty Care and Exfil Planning09:59 Medical Supplies: Drugs, Medications, and Sterility10:42 Camp Craft and Bushcraft Skills for Remote Medics11:35 Wildcrafted Plants and Improvised Medicine12:12 Communication Strategies in Dense Canopy Environments13:08 Team Coordination and Role Assignments14:08 Dealing with Critical Patients and Exfil Decisions14:57 Infection Control and Hygiene in the Field15:54 Personal and Team Safety Measures16:39 Additional Non-Medical Gear for Remote Operations17:16 Lighting Solutions and Bug Management at Night18:08 Medications and Drugs for Jungle Medicine18:45 Over-the-Counter and Emergency Medications19:34 Special Considerations for Malaria and Vector-borne Diseases20:04 Infection Control and Hygiene Protocols20:56 Water Purification and Boiling Techniques21:35 Field Sterilisation and Maintaining Sterility22:25 Managing Glove Supplies and Hand Hygiene23:00 Dermatology and Common Skin Conditions23:38 Malaria Prophylaxis and Treatment Strategies24:32 Infection Control and Personal Hygiene25:14 Power and Charging Solutions in Remote Areas26:04 Water Supply and Filtration Methods26:45 Field Sterilisation and Water Boiling Techniques27:21 Camp Craft and Bushcraft Skills for Field Survival27:56 Wildcrafting and Medicinal Plants in the Jungle28:47 Communication Equipment and Strategies in Dense Canopy29:41 Team Coordination and Medical Decision-Making30:17 Water Safety and Potable Water Management31:05 Team Safety and Preventing Illness in the Field32:04 Bushcraft Skills for Remote Medical Operations32:58 Survival Skills and Improvised Medicine33:48 Communication Tools and Emergency Signalling34:28 Exfil Planning and Evacuation Protocols35:14 Prolonged Casualty Care and Equipment Needs36:01 Medical Kits and Supplies for Extended Operations36:51 Decision-Making in Critical Situations37:23 Non-Medical Essentials: Woobies, Tools, and Comfort Items38:10 Maintaining Morale and Team Cohesion38:42 Summary and Final Tips for Jungle ICU Setup

This week, Aebhric O’Kelly talks with Dr Csaba Dioszeghy about the redesign and upgrade of the MSc Austere Critical Care programme. Every 5 years, the degree programmes undergo reaccreditation. The College has decided to double the programme's size following feedback from graduates. Chapters00:00 Introduction to the New Masters of Austere Critical Care Program01:03 The Complete Rehaul of the Curriculum01:57 Flexibility and Pathways in the New Program02:51 Comparison with UK Advanced Practice Programs03:46 Four Pillars of the New Curriculum04:41 Special Focus: Medical Support to Resistance Healthcare07:02 Innovations in Improvised Medicine08:21 Practical Modules: Ultrasound and Tropical Medicine09:44 Student Research and Thesis Projects11:30 Program Launch and Future Outlook

This week, Aebhric O'Kelly and Bill Vasios host another CoROM Conversations. This month, they discuss the comprehensive nursing interventions, training strategies, and best practices for prolonged field care, emphasising simplicity, effective handovers, and patient safety.https://youtu.be/U63NaFLaxZ0Chapters00:00 Introduction to Nursing Interventions00:53 Exploring CPGs and Nursing Interventions02:25 Comparing Non-Medical and Medical Personnel Guidelines05:50 Simplifying Nursing Interventions for Non-Medical Personnel09:05 Wound Care Disparities in Guidelines11:05 Identifying Gaps in Nursing Care Guidelines12:07 The Need for Simplified Guidelines16:15 Importance of Structured Handover24:03 Trending and Serial Assessment in Patient Care26:17 Understanding Patient Comfort and Injury Prevention27:36 The Importance of Hands-On Nursing28:32 Pressure Injury Prevention Strategies29:52 Efficient Patient Care Techniques31:17 Pain Management in Nursing33:12 Pulmonary Hygiene and Patient Mobility35:14 Nutrition and Hydration in Patient Care35:37 The Role of Checklists in Medical Practice41:33 Infection Prevention and Wound Care43:34 Final Thoughts on Patient Care Practices44:01 Any Questions?

This week, Aebhric O'Kelly interviews four students from our BSc in Remote Paramedic Practice programme. They discuss the Tropical Travel and Expedition Medical Skills course (TTEMS).

This week, we hear from Burjor Langdana, who runs the Wilderness and Expedition Dentistry workshop for CoROM. Burjor discusses the management of dental pain, focusing on assessing sensitivity, identifying causes, and evaluating treatment options. It emphasises the importance of patient care, oral hygiene, and antibiotic use in the management of dental conditions. The discussion also covers cultural considerations and improvisation in emergency situations, providing valuable insights for dental practitioners.https://wildernessdentistry.com/TakeawaysUnderstanding the characteristics of dental sensitivity is crucial.Location and duration of pain are key indicators.Aggressive brushing can lead to gum recession and sensitivity.Clove oil can be effective but should be used cautiously.Flossing is essential to prevent food buildup and gum irritation.Antibiotics may be necessary for managing infections.Improvisation is important in emergency dental care.Cultural beliefs can impact patient care and treatment acceptance.Communication with patients about procedures is vital.Managing expectations regarding treatment outcomes is essential.Chapters00:00 Introduction to Managing Dental Pain00:57 Understanding Sensitivity: Duration and Location06:32 Identifying Causes of Sensitivity12:12 Managing Sensitivity with Home Remedies12:40 Addressing Food-Related Pain18:37 Techniques for Filling Cavities29:11 Improvising Without Instruments29:39 The Role of Salt Water in Oral Health34:53 Managing Tooth Pain and Food Impaction39:06 Understanding Fillings and Their Complications45:42 Gumboils: Causes and Management49:48 Skills for Remote Dental Care56:04 Cultural Sensitivity in Dental Treatment

This week, Aebhric O’Kelly is joined by Rabbit, who is an EU SOF medic who shares his extensive background in military medicine and his current focus on researching the effects of higher education on individuals with PTSD. He discusses his personal experiences with PTSD and how education has played a role in his recovery. The conversation also touches on the importance of engaging the younger generation in military medicine, adapting to the changing battlefield, and the need for collaboration between special operations and conventional forces. Rabbit emphasises the significance of education and teamwork in improving outcomes for those affected by trauma.TakeawaysRabbit has a rich background in military medicine and education.His PhD research focuses on PTSD and higher education.Education can provide hope and support for individuals with PTSD.There is a need for specialised programs for military personnel with PTSD.Engaging the younger generation is crucial for the future of military medicine.Collaboration between special operations and conventional forces is essential.Rabit emphasises the importance of teaching and enabling others in medicine.The battlefield is evolving with new technologies and challenges.Personal experiences with PTSD can inform research and treatment.Teamwork is vital in prolonged field care situations.Chapters00:00 Introduction to Rabbit and His Background02:52 Exploring PTSD and Higher Education10:22 Personal Experiences with PTSD and Education17:12 The Role of SOMA and Engaging the Younger Generation26:57 Advice for New Medics and Collaboration in Medicine

This week, Aebhric O’Kelly, Bill Vasios, and Rhod Jordan lead an open discussion examining the critical role of nutrition in prolonged field care. The conversation explores enteral and parenteral feeding modalities, outlining their respective indications, benefits, and practical limitations in austere and resource-constrained environments. Particular emphasis is placed on the value of early nutritional intervention in supporting physiological recovery, including practical techniques for nasogastric tube placement and for identifying and managing feeding-related complications. The discussion further considers the challenges of maintaining nutritional support during patient transport. It highlights the importance of interdisciplinary collaboration, including consultation with nutrition specialists, to develop safe and effective nutritional care plans.TakeawaysNutrition is crucial in prolonged field care.Enteral nutrition is less invasive and safer.Early feeding improves healing and recovery.Consult a nutritionist for feeding plans.NG tubes can reduce complications in feeding.Monitor for complications during feeding.Parenteral nutrition may be necessary in some cases.Feeding techniques can vary based on patient condition.Understanding nutritional needs is essential for care.Future discussions will focus on advanced topics.Chapters00:00 Introduction to Prolonged Field Care and Nutrition02:40 Understanding Enteral and Parenteral Nutrition04:53 Benefits of Early Nutritional Support07:47 Indications and Contraindications for Feeding09:32 Practical Considerations for Feeding in Austere Environments11:51 Calculating Nutritional Requirements14:30 Challenges in Nutritional Support During Transport17:16 Techniques for NG Tube Placement20:00 Monitoring and Managing Feeding Complications22:19 Discussion on Parenteral Nutrition24:41 Conclusion and Future Topics