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

1d ago

211-CaBAMiquine One Dose Malaria Treatment?

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.

Aug 28

210-Lessons from Northern Sweden and Ukraine

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.

Aug 21

209-Ten years of CoROM Rethinking How We Teach Austere Medicine

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.

Aug 14

208-WEM with Prof Mark Hannaford

Aug 7

207-OTC Drugs for Austere Primary Care

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 AssessmentOral rehydrationLoperamide: when to use it (and when not to)06:54 – Upper respiratory infections Symptom managementSalt-water garglesSaline spraysWhen antibiotics are unnecessary13:34 – Musculoskeletal injuries Pain packsDiclofenacPatient-guided pain managementRICE and the ice debate20:45 – Allergic rashes and contact dermatitis HydrocortisoneAntihistaminesOatmealRecognising anaphylaxis23:02 – Insect bites and stings Local treatmentCold therapyWhen to escalate care25:21 – Dehydration Oral rehydrationIV versus oral fluidsHydration strategies in the field29:59 – Heat illness Cooling methodsField managementPreventing heat injury32:15 – Acid reflux in austere environments AntacidsGingerPractical management tips32:15 – Minor wound care IrrigationSoap versus antisepticsDakin's solutionAlcohol and iodinePractical wound cleaning36:45 – Building the ideal austere OTC medical kit Essential medicationsDressingsTapeWater purificationSplintsEpiPensMulti-use equipment41:20 – Final discussion, audience questions and wrap-up The discussion concludes by assembling a practical remote medicine kit, including: Oral Rehydration Salts (ORS)ParacetamolIbuprofenLoperamideAntacidsOral antihistaminesHydrocortisone creamAntifungal creamTopical diclofenacZinc oxide tapeCohesive bandage (Coban/Vet Wrap)SalineSoapCling filmDressingsGauzeSunscreenWater purification equipmentSAM splintsEpiPenCompact 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.

Jul 31

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. 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

Jul 24

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. 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

Jul 17

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. 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.

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

Episodes

211-CaBAMiquine One Dose Malaria Treatment?

210-Lessons from Northern Sweden and Ukraine

209-Ten years of CoROM Rethinking How We Teach Austere Medicine

208-WEM with Prof Mark Hannaford

207-OTC Drugs for Austere Primary Care

206-World Extreme Medicine Fund with Luca Alfatti

205-Good ALS starts with great BLS with David Stanton

204-Frontline Medic in Ukraine

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