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

This week, Aebhric O’Kelly is joined by Rob Schembri, a Canadian critical care paramedic with Ornge, Ontario’s air ambulance service, and a student on CoROM’s MSc in Austere Critical Care.Rob discusses his journey through critical care paramedicine, his recent move onto a special operations team and why, after decades in the profession, he decided to pursue postgraduate education in austere medicine. His new role includes supporting the transport of patients with high-risk pathogens and mechanical cardiac support, as well as USAR and other specialist operations. The conversation explores the Canadian paramedic system, including the progression from Primary Care Paramedic to Advanced Care Paramedic and ultimately Critical Care Paramedic. Rob explains the extensive training required at the critical care level and how international paramedics can enter the Ontario system. Rob also talks candidly about undertaking his first research project, navigating ethics approval and discovering that the thesis he initially dreaded has become one of the most interesting parts of his MSc.The episode finishes with a discussion about lifelong learning, career development and Rob’s advice to clinicians beginning a career in austere medicine: learn as much as you can, experience as much as you can—and enjoy what you do. Chapters00:00 – Meet Rob Schembri: Critical care paramedicine, Ornge and joining the special operations team.01:18 – The Malta Connection: Rob's Maltese heritage and his family's move to Canada.03:03 – Returning to Malta for a Master's Degree: The irony of pursuing postgraduate education in the country his parents left.03:25 – Why the MSc in Austere Critical Care?: Preparing for specialist critical care and special operations.05:02 – High-Risk and Special Operations Medicine: High-risk pathogens, mechanical cardiac support, USAR and specialist transport.06:50 – Why Study Austere Critical Care in Malta?: Choosing CoROM rather than a conventional Canadian critical care programme.08:18 – POCUS and Future Training: Bringing austere prehospital ultrasound into specialist practice.11:05 – Reaching the MSc Thesis: Rob's progress through the programme.11:36 – Researching Cognitive Load in Austere Conditions: Identifying a gap in conventional critical care paramedic training.13:32 – Designing the Research: Comparing conventional scenarios with scenarios incorporating austere stressors.15:02 – From Dreading Research to Enjoying It: Becoming a first-time clinical researcher.16:01 – Research Ethics: The challenges of preparing an ethics submission.17:42 – Why an MSc Should Include Research: Thesis versus coursework and what it means to earn a Master of Science.19:42 – What Comes After the MSc?: PhDs, lifelong education and knowing when to give the family a break.20:32 – Taking a Maltese MSc Back to Canada: Recognition, professional development and teaching opportunities.22:31 – How Canadian Paramedicine Works: PCP, ACP and Critical Care Paramedic pathways.24:43 – Moving Between Canadian Provinces: Reciprocity and employment across provincial systems.25:40 – Is There a Canadian Paramedic Registry?: How Ontario regulates and identifies paramedics.26:59 – International Paramedics Coming to Ontario: Where UK, Australian, South African and other clinicians may fit.28:09 – Comparing US and Canadian Paramedic Education: Training pathways and entry into critical care practice.30:06 – Becoming a Critical Care Paramedic in Ontario: The 16–18-month training process and clinical placements.31:17 – “It's Never Too Late”: Rob became a critical care paramedic in his fifties.32:04 – What Would Rob Do Differently?: Looking back on the MSc and a 36-year career.32:54 – Advice for the Next Generation: Learn, experience, enjoy your work and value the people around you.33:53 – Coming Home to Malta: Pastizzi, cannoli and plans to finally meet in person.

In this episode of the CoROM Podcast, Aebhric O'Kelly speaks with Kevin Fox, a Belgian EMT, maritime security professional and recent graduate of CoROM's BSc in Remote Paramedic Practice.Kevin's journey into medicine began following the 2016 Brussels terrorist attacks. Working in security at the time, he realised he lacked the medical knowledge to help casualties in a similar emergency. That experience eventually led him through tactical medical training, Belgian EMT education and CoROM's three-year degree.Kevin discusses his clinical placements in South Africa and Suriname, where he gained experience managing polytrauma, paediatric emergencies, childbirth and tropical infectious diseases. He describes how resource limitations challenged him to improvise, adapt and develop clinical judgement while working alongside local medical teams.The conversation then turns to tropical medicine in Europe. Kevin shares two memorable ambulance cases involving patients returning from India and Italy, explaining how a detailed travel history helped him recognise possible malaria and dengue. These experiences inspired his proposed research into incorporating recent travel more explicitly into prehospital patient assessment.Kevin also discusses his dissertation on Belgium's dengue preparedness, the importance of community education and his plans for further research and postgraduate study.Finally, he reflects on his three years at CoROM, the value of supervised clinical placements and the importance of recognising one's limitations. His advice to clinicians entering remote medicine is simple: test your equipment, remain self-critical and never become a toxic leader.00:00 – Introducing Kevin Fox: From maritime security to remote paramedicine.01:04 – The Brussels Terrorist Attacks: The event that inspired Kevin to pursue medical training.03:05 – Why a Bachelor's Degree?: Professional development and European academic recognition.04:30 – Future Academic Ambitions: Tropical medicine and postgraduate opportunities.06:34 – Clinical Placements in Suriname: How TTEMS prepared Kevin for remote clinical practice.08:35 – Why Suriname?: Language, culture and healthcare challenges.10:30 – Working in a Surinamese Emergency Department: Trauma assessment and growing clinical responsibility.13:12 – Memorable Clinical Cases: Polytrauma, paediatric emergencies and delivering a baby.14:54 – Tropical Diseases in Suriname: Dengue, chikungunya and patients presenting with sepsis.16:51 – Knowing Your Limitations: Clinical supervision, teamwork and asking for help.20:10 – Three Years at CoROM: Practical training, student experiences and suggestions for improvement.23:11 – Advice for First-Year Students: Why anatomy and physiology matter later in clinical practice.25:28 – Kevin's Dissertation: Dengue preparedness and the establishment of tiger mosquitoes in Belgium.28:44 – The Importance of Travel History: Recognising malaria in a patient returning from India.30:00 – Could It Be Dengue?: A patient returning from Italy challenges clinical assumptions.32:01 – The SAMPLER Research Project: Investigating tropical fever recognition among Belgian ambulance personnel.33:48 – Tropical Medicine in Europe: Why clinicians need to consider emerging and imported infections.35:19 – UK Paramedic Registration: Kevin's professional plans after graduation.36:05 – Maritime and Offshore Medicine: Combining paramedicine with maritime security.37:05 – Continuing Education: Tropical medicine, clinical laboratory skills and professional networks.39:02 – Advice for Austere Clinicians: Never assume, remain self-critical and avoid toxic leadership.40:25 – Closing Remarks.Chapters

In this episode of CoROM Conversations, Bill Vasios is joined by Dr Bob Dichiera, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University's PA programme. Bob introduces a practical approach to remote orthopaedics built around four questions: Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation?The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated pulse, motor and sensory (PMS) assessment before and after interventions. Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise.The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments.00:00 – Tuning-fork fracture diagnosis cold open00:18 – Introduction to Remote Orthopaedics01:58 – Why MSK injuries matter in remote medicine03:00 – Orthopaedic emergencies you cannot miss04:18 – Damage-control orthopaedics05:00 – Is the patient dying? Is the limb dying?06:42 – Closed tibial fractures07:40 – Diagnosing fractures with a tuning fork09:06 – Splinting and traction decisions11:31 – Compartment syndrome14:00 – Pain with passive stretch15:30 – Open fractures16:20 – Irrigation17:00 – Antibiotics for open fractures21:06 – Field splinting and improvised splints23:30 – Shoulder dislocations25:55 – Shoulder reduction techniques28:21 – Immobilisation and rehabilitation30:45 – When should remote clinicians reduce a dislocation?33:07 – PMS and neurovascular assessment34:00 – Knee dislocations35:35 – The easily missed vascular injury37:56 – Reduction, ABI and evacuation38:45 – Ankle injuries and Ottawa Ankle Rules40:20 – Why weight-bearing does not exclude fracture42:00 – Hand and wrist injuries42:43 – Pelvic fractures44:00 – Pelvic binders and avoiding repeated pelvic assessment45:30 – Haemorrhage and pelvic trauma46:00 – Pelvis versus femoral neck fracture47:30 – Ultrasound in remote orthopaedics47:50 – Should remote clinicians perform fasciotomies?48:30 – Telemedicine and remote procedural guidance49:53 – Closing

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.Chapters00:00 – 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.Chapters00:00 – 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.