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

College of Remote and Offshore Medicine
  • 4.9 (8)
  • Non-Profit
  • Updated Weekly

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

  1. 2d ago

    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

    205-Good ALS starts with great BLS with David Stanton

  2. 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.

    204-Frontline Medic in Ukraine

  3. Jul 10

    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 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.

    203-Austere Primary Care Webinar

  4. Jul 3

    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. 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.

    202-A Life in Medicine with Dr Winston de Mello

  5. Jun 26

    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. 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

    201-Doctorate in Health Studies with Dr Ella Corrick

  6. Jun 19

    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. 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.

    200-CoROM Founders discuss 10 years of CoROM

  7. Jun 12

    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. Chapters 00:00 – Introduction to Snake Envenomation 01:45 – Why Snake Bites Matter in Austere Medicine 04:00 – Snakebite Myths and Immediate First Aid 05:00 – The Four Envenomation Syndromes 08:00 – Operational Planning and Antivenom Selection 11:20 – Understanding the JTS Treatment Algorithms 16:00 – Case Study: Pit Viper Envenomation 22:00 – Determining When Antivenom Has Worked 24:00 – Antivenom Dosing Principles 26:00 – Field Diagnostics and Coagulopathy Assessment 28:00 – Neurotoxic Snake Bites and Respiratory Failure 33:00 – Why Identifying the Snake Often Doesn't Matter 34:00 – Dry Bites and Return-to-Duty Decisions 36:00 – Antivenom Reactions and Anaphylaxis Management 39:00 – Tourniquets, Pressure Bandages, and Controversies 46:00 – Life Over Limb? Risk-Benefit Decision Making 51:00 – Airway Management in Neurotoxic Envenomation 55:00 – Regulatory Challenges and Deployment Considerations 57:45 – Key Take-Home Messages

    199-Snake Bites with Dr Evan Baines

  8. Jun 5

    198-eFAST for Combat Life Savers with TacMedNorth

    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. Chapters 00:00 – Introduction 01:06 – Can Non-Medics Learn Ultrasound? 03:00 – Lessons from the APUS Course 05:30 – The Power of Home Points07:50 – What is Tactical APUS? 10:00 – Adapting eFAST for Combat Operations 12:30 – Hypothermia Prevention During Ultrasound 15:20 – The Controversial Change: Heart Last 20:00 – PLAX vs Subxiphoid Cardiac Views 24:40 – Teaching Maltese Nurses 29:10 – Should We Teach Ultrasound to Combat Lifesavers? 32:20 – Ultrasound as a Triage Tool 35:10 – Advice for Future Tactical Ultrasound Providers 38:00 – Closing Remarks Key Takeaways The 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.

    198-eFAST for Combat Life Savers with TacMedNorth
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4.9
out of 5
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About

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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