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

This week, Aebhric O'Kelly speaks with Dr Travis Kaufman and they explore his 25-year US Army career, his transition from combat engineer and military diver to Physician Assistant (PA), and five years providing medical support through the White House Medical Unit.
Travis describes one of the most difficult lessons emerging from Ukraine: prolonged tourniquet use. A Ukrainian medic explains the decision as “triage of the limb or the life” when attempting tourniquet conversion after several hours may place the casualty at considerable risk.
The discussion examines unnecessary tourniquet use, the importance of reassessment, contaminated wounds and the increasing problem of sepsis when evacuation is delayed for hours or days. Travis argues that the traditional TCCC assumption of rapid evacuation can create a training scar when casualties instead remain with combat lifesavers and medics for prolonged periods.
The episode then explores what PCC actually looks like in practice: trending observations, wound debridement, antimicrobial planning, pain management, positioning, pulmonary care and the fundamental nursing interventions that can determine whether a casualty deteriorates.
Travis also shares examples of improvisation from the field, including improvised PEEP and wound-vacuum techniques, and discusses why clinicians need to rediscover simple solutions when sophisticated equipment is unavailable.

Chapters
00:00 – Meet Dr Travis Kaufman: From Army diver to PA, White House medicine and Ukraine.
02:26 – Becoming a Military Deep-Sea Diver: Training, attrition and operational diving.
06:12 – From Diver to Physician Assistant: Changing careers and entering military medicine.
07:15 – What Is a Physician Assistant?: Origins, training and the military PA role.
10:38 – PA vs Nurse Practitioner: Different educational and clinical models.
13:06 – Advising Across Eastern Europe: Building capability and interoperability.
14:19 – Inside the White House Medical Unit: Medical support for the President and First Family.
15:35 – Medical Planning for the President: Preparing for presidential travel worldwide.
17:32 – Training for High-Consequence Medicine: Trauma preparation and live-tissue training.
19:43 – Humanitarian Medicine in Tanzania: Wilderness medicine and community healthcare.
21:00 – Schistosomiasis and Sickle-Cell Care: Managing disease in resource-limited communities.
24:40 – HIV and the Problem of Follow-Up: When treatment exists but access remains difficult.
27:07 – Inside a Ukrainian Stabilisation Point: Damage-control resuscitation with limited resources.
28:45 – The Limb or the Life: The realities of prolonged tourniquet use.
30:00 – Preventing Unnecessary Limb Loss: Tourniquet reassessment and conversion.
31:56 – Sepsis in Prolonged Casualty Care: The consequences of delayed evacuation.
33:30 – Debridement Without Water: Managing contaminated battlefield wounds.
34:47 – Airways with Limited Equipment: Facial trauma and conserving resources.
36:14 – Taking PCC to the CLS and CMC: Moving prolonged-care skills further forward.
39:09 – What Should a Two-Day PCC Course Teach?: Reassessment, wounds and prolonged-care thinking.
40:45 – Stop Taking Snapshots — Start Trending: Following physiology over time.
42:13 – The “Boring” Care That Saves Lives: Nursing care, positioning, pain and pulmonary management.
43:40 – Improvised PEEP and Wound VACs: Field-expedient solutions when equipment runs out.
45:13 – Rediscovering Old Lessons: What previous wars may teach modern austere medicine.
46:27 – Medicine in the Mediterranean: Travis previews his keynote presentation.
47:45 – “Sir, Are We Gonna Be Okay?”: Trust, responsibility and caring for severely wounded soldiers.
49:49 – Advice for the Austere Clinician: Lose the ego, stay curious and learn from experience.

This week, Aebhric O'Kelly is joined by David Page, a paramedic with more than 40 years of experience spanning frontline EMS, education, accreditation and research. David directs the Prehospital Care Research Forum at UCLA and is closely involved with the International Paramedic Registry (IPR).
The conversation explores the enormous variation in paramedic education and practice around the world. David discusses his work with training centres in more than 20 countries and explains why sophisticated simulation facilities are not necessarily required to deliver excellent education.

Chapters
00:00 – Meet David Page: 40 years of paramedicine, research and education.
01:45 – Assessing EMS Education Around the World: Lessons from training centres in 23 countries.
04:30 – Simulation Without the Million-Dollar Lab: Creating effective training with limited resources.
05:20 – What Is the International Paramedic Registry?: Establishing international standards for paramedicine.
08:01 – Learning from the US National Registry: Why independent certification matters.
10:28 – Defining Levels of Paramedicine: Responder, basic and advanced practice.
13:03 – What Should Every Paramedic Know?: Building and validating 1,028 international competencies.
17:32 – Is IPR Becoming an International Standard?: Adoption, recognition and international mobility.
19:44 – Certification vs Licensure: An important distinction for international paramedics.
21:47 – Degree vs Certification: Does graduating from university prove clinical competency?
26:47 – Does a Degree Guarantee Competence?: Why David argues for independent verification.
28:20 – US vs UK Paramedics: Who Is Better?: Why minimum standards matter more than comparison.
29:17 – When the Same Job Title Means Different Skills: Comparing paramedic education and scope internationally.
30:35 – Does Programme Length Matter?: Why three years of education can mean very different things.
33:40 – Australia's Nurse–Paramedic Model: Different professions and different clinical environments.
36:43 – The UK Paramedic Model: Degrees, registration and the changing ambulance workforce.
39:36 – Germany, Spain and European EMS: Different routes to prehospital practice.
41:50 – Does France Have Paramedics?: Looking beyond professional labels.
44:12 – Can Nurses Take the IPR Exam?: Why hospital expertise does not automatically equal prehospital expertise.
44:52 – Paramedicine Is a Specialty: A separate environment requires a separate body of knowledge.
45:25 – Research, Education and Clinical Practice: David's three-legged stool of paramedicine.
46:56 – “Soak It Up, Buttercup”: David's advice for the next generation.
47:38 – The Privilege of Being a Paramedic: Human dignity, patients and why the work matters.

This week, Aebhric O'Kelly is joined by Jason Jarvis, a former US Army Special Forces medic, tropical medicine educator, and researcher, for a practical discussion of malaria management in remote and resource-limited environments.
Jason reviews the malaria parasite life cycle and explains why understanding the liver and blood stages is important when selecting treatment. The discussion covers current management with artemether–lumefantrine (Coartem) for uncomplicated malaria and IV artesunate for severe disease.
Prevention remains essential. Jason discusses bed nets, repellents and chemoprophylaxis, including Malarone, doxycycline and mefloquine, along with the advantages and adverse effects of each.
The centrepiece of the episode is cabamiquine–pyronaridine. Jason discusses the recent Phase 2a research and two particularly exciting possibilities: single-dose treatment and potential activity against multiple stages of the malaria parasite. If subsequent trials support these findings, this could significantly simplify malaria treatment, particularly in remote settings where adherence to multi-dose regimens can be difficult. Jason also emphasises that cabamiquine remains investigational and requires further clinical evaluation.
The conversation also explores antimalarial resistance, G6PD considerations, R21 and RTS,S malaria vaccines, and the importance of antimicrobial stewardship.
Finally, Jason brings the discussion back to the remote medic: prevent mosquito bites, ensure chemoprophylaxis is taken, carry appropriate contingency treatment and have a realistic diagnostic plan. The episode closes with a discussion of microscopy, malaria rapid diagnostic tests (RDTs), and clinical diagnosis when neither is available.

00:00 – Jason Jarvis Returns: Tropical medicine and infectious-disease education.
02:00 – What Is Malaria?: Understanding the parasite.
04:30 – The Malaria Life Cycle: Mosquito, liver and blood stages.
07:00 – Treating Malaria Today: Current antimalarial therapy.
08:10 – Coartem or IV Artesunate?: Uncomplicated versus severe malaria.
09:15 – Preventing Malaria: Bed nets, repellents and mosquito avoidance.
10:00 – Chemoprophylaxis: Malarone, doxycycline and mefloquine.
11:15 – The Remote Medic's Malaria Kit: Prevention and contingency treatment.
13:30 – Mefloquine and the Nightmares: Benefits and neuropsychiatric effects.
16:15 – Introducing Cabamiquine: A potential new antimalarial.
17:30 – The Phase 2a Trial: Early clinical evidence.
20:30 – Could One Dose Treat Malaria?: The potential for single-dose treatment.
21:15 – The Resistance Problem: Protecting new antimalarials.
22:15 – Why One Dose Matters: Potential benefits in remote settings.
23:00 – Targeting Multiple Parasite Stages: Potential liver and blood-stage activity.
24:00 – Cabamiquine and Primaquine: Implications for liver-stage treatment.
25:30 – What About G6PD?: An important unanswered question.
26:15 – The Future of Malaria Treatment: Could treatment become considerably simpler?
27:10 – Malaria Vaccines: R21 and RTS,S.
28:40 – Antimalarial Resistance: Lessons from Southeast Asia.
30:00 – Advice for the Remote Medic: Practical preparation for malaria.
32:30 – Diagnosing Malaria in the Field: Microscopy and diagnostic planning.
34:15 – Choosing a Malaria RDT: HRP2 and pLDH testing.
35:30 – No RDT, No Microscope: Clinical diagnosis and presumptive treatment.
37:00 – Final Thoughts: Key lessons for austere clinicians.

This week, Aebhric O'Kelly speaks with Christoffer Mäkitalo, a Swedish ambulance and anaesthesia nurse whose career spans remote prehospital care, the Swedish Civil Defence and Resilience Agency, military medicine and repeated training deployments to Ukraine.
For Christoffer, prolonged care is not an unusual operational scenario. After 20 years working in northern Sweden, long response and transport times are part of routine ambulance practice. A call may involve a 45–60-minute response, followed by several hours of transport to a hospital capable of providing the required definitive care. With limited ambulance and helicopter resources covering enormous distances, clinicians must continually balance clinical need, transport decisions and system availability.
The conversation then moves to Ukraine, where Christoffer has worked alongside Tactical Medicine North to support the development of TCCC, Combat Lifesaver, Combat Medic/Corpsman, instructor, blood resuscitation and ultrasound training. His next deployment will include piloting a two-day prolonged field care programme aimed at the CLS level.
A central theme is that the changing battlefield requires prolonged casualty care skills to move further forward. Casualties may remain with combat lifesavers and medics for extended periods, making seemingly basic nursing interventions, keeping patients clean, dry and warm, managing elimination, monitoring wounds and preventing complications, increasingly important. As Christoffer puts it, many combat lifesavers had no healthcare background before the war; skills clinicians consider obvious must therefore be deliberately taught.

Chapters
00:00 – Introduction: Christoffer Mäkitalo
Twenty years of prehospital medicine, military nursing and civil defence work in northern Sweden.
01:41 – When Prolonged Care Is Just Normal Care
Why one-hour-plus evacuation timelines are an everyday reality for ambulance clinicians in northern Sweden.
03:44 – Medical Training in Ukraine
Christoffer's repeated deployments and the evolution from basic TCCC towards instructor development, blood resuscitation and ultrasound.
06:20 – Taking Prolonged Casualty Care to the CLS
Piloting a two-day prolonged field care programme and why these skills need to move beyond highly trained medical personnel.
09:16 – Nursing Skills on the Modern Battlefield
Wound care, hygiene, keeping casualties dry and warm, elimination and other fundamental care when evacuation is delayed.
11:34 – The Battlefield Has Changed
Why assumptions based on rapid evacuation and air superiority no longer reflect the realities being reported from Ukraine.
12:56 – Sweden's Civil Defence and Resilience Agency
Humanitarian operations, international deployments and supporting UN and EU missions around the world.
17:12 – Working as a Swedish Combat Nurse
Combining civilian clinical practice with military medicine
19:49 – Remote Ambulance Medicine in Northern Sweden
Working with limited resources, long distances and the need to become an effective clinical problem-solver.
23:28 – When HEMS Is Not Available
Deciding when to request helicopter support and the operational challenges of weather, icing and enormous geographical coverage.
26:23 – Cross-Border Rescue and Evacuation
Cooperation with Norwegian and Finnish services and the capabilities available across Scandinavia.
27:28 – The Swedish Ambulance Nurse
Education, scope of practice, anaesthesia training and differences between civilian and military clinical capabilities.
30:36 – Treat, Release or Transport?
Why does transporting every patient simply not work when one ambulance journey can take six to eight hours?
33:26 – Fixed-Wing Evacuation
Moving patients over long distances for specialist and critical care unavailable locally.
35:14 – Advice for the New Austere Clinician
Curiosity, humility, lifelong learning and finding the area of medicine that genuinely matters to you.

Aebhric O'Kelly is joined by Dr Csaba Dioszeghy, CoROM co-founder and CEO, critical care and emergency medicine consultant, cardiologist, and experienced prehospital clinician.
The conversation explores what makes education for remote and austere clinicians fundamentally different from conventional medical education. CoROM students work across the world in military, humanitarian, offshore and other resource-limited environments. Csaba discusses why education needs to adapt to these clinicians rather than expecting their professional lives to conform to a traditional university model.
A major theme is listening to students. Aebhric and Csaba discuss how student feedback has directly influenced CoROM's curriculum, facilities, administration and teaching methods — including significant changes being introduced for the new academic year.
They also discuss the redevelopment of the MSc in Austere Critical Care, including more interactive online learning, greater flexibility for students who cannot travel to Malta, and expanded opportunities for practical education. The discussion considers an important question for modern medical education: how much of postgraduate austere medicine can genuinely be taught online, and what still requires hands-on experience?

Chapters
00:00 – Welcome to Season 5
A new academic year, a new podcast season and the changing face of CoROM.
00:38 – CoROM's Next Chapter
Csaba's role as CEO, consolidating a decade of growth and the College's ambitions for the future.
03:02 – What Makes CoROM Different?
Building flexible education for clinicians working across military, humanitarian, offshore and resource-limited environments.
06:52 – Listening to Our Students
How student feedback directly influences curriculum, facilities and the way CoROM teaches.
09:23 – Changing the Practical Curriculum
Revamping classroom education, investing in facilities and placing greater emphasis on hands-on learning.
11:34 – Rebuilding the MSc in Austere Critical Care
New modules, interactive education and moving beyond traditional recorded online lectures.
13:07 – Can You Teach Austere Critical Care Online?
Accessibility, international students and why the redesigned MSc can now be completed without compulsory travel to Malta.
18:01 – Improving Support for Online Students
Human faculty support, central administration and improving communication with students.
19:54 – Building a Better Student Information System
Modernising the administrative infrastructure behind a growing international College.
21:02 – Building the CoROM Community
The future of CoROM's membership structure and strengthening the wider professional community.
23:05 – The CoROM Digital Library
Building offline access to field guides, publications and educational resources.
25:41 – A New Digital and Physical CoROM
New content, facilities, Moodle, equipment and the systems being developed for the new academic year.
28:05 – Quality Assurance and the Future of CoROM
Institutional review, reaccreditation and the longer-term direction of the College.
29:33 – More Hands-On, Less PowerPoint
Updating the BSc and MSc programmes and increasing practical learning when students come to Malta.
32:17 – International Partnerships
Growing educational, clinical and research relationships around the world.
34:02 – Advice for the New Austere Medic
What should a doctor, nurse or medic entering austere medicine concentrate on?
35:00 – When Guidelines Don't Fit the Environment
Why guidelines developed in well-resourced healthcare systems may not always translate directly into resource-limited care.
36:02 – Your Brain Is Still a Resource
Understanding physiology, thinking beyond protocols, innovation and Csaba's final advice: be brave and don't give up.