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

This week, Aebhric O'Kelly speaks with Axel Ernir Viðarsson, an advanced EMT, firefighter and search and rescue instructor based in Akureyri, northern Iceland.With more than 20 years of volunteer search and rescue experience, Axel offers fascinating insight into Iceland's emergency medical services, wilderness rescue operations, and the challenges of delivering prehospital care in one of Europe's most geographically demanding environments.Chapters00:00 – Introduction to Axel Ernir Viðarsson01:18 – Rescue 26: Iceland's International Search and Rescue Conference03:27 – Bringing Prehospital Ultrasound to Iceland05:39 – The Future of POCUS in Icelandic Ambulance Services07:15 – Firefighting, Ambulances and Fixed-Wing Air Evacuation09:55 – What Is a Smoke Diver?11:34 – How Iceland's EMS and Search and Rescue Systems Work Together13:26 – Volcanic Eruptions and Search and Rescue Operations16:29 – Tourist Rescues, Blizzards and Wilderness Emergencies17:56 – Iceland's Paramedic Education and Overseas Training19:41 – Designing the Ideal Icelandic EMS System21:22 – Advanced EMT Training in Iceland24:44 – Could CoROM's BSc Remote Paramedic Practice Work in Iceland?27:17 – Prolonged Patient Care in Iceland's Remote Wilderness29:32 – Coordinating EMS, Search and Rescue and Air Ambulance Evacuation32:29 – Choosing Between Akureyri and Reykjavík Hospitals33:26 – When the Patient Is Nothing Like the Dispatch Report34:29 – Axel's Journey into Search and Rescue37:06 – Becoming a Wilderness Medicine Instructor38:54 – Teaching, Avalanche Rescue and Wilderness First Aid40:11 – Why Austere Medicine Makes Better Clinicians41:21 – Learning from Students and Fellow Instructors42:32 – Advice for New Austere Medicine Practitioners43:38 – Getting Involved in Conferences and Professional Education44:26 – Final Thoughts and Future CoROM Training in IcelandTopics Discussed- Icelandic emergency medical services and advanced EMT practice- Volunteer search and rescue and the Icelandic Association for Search and Rescue (ICE-SAR/ISAR)- Volcanic eruptions, avalanche rescue and wilderness emergencies- Fixed-wing air ambulance operations and Coast Guard helicopter evacuation- Prolonged field care and remote patient transport- Point-of-care ultrasound in prehospital medicine- Advanced EMT and paramedic education pathways- International collaboration in remote paramedic education- Wilderness medicine instruction and professional development- The importance of networking, conferences and lifelong learning

This week, Aebhric O'Kelly speaks with John Crofts, a nurse working at Zuckerberg San Francisco General Hospital, the city's Level I trauma centre. John brings an extraordinary perspective to austere medicine, combining emergency nursing, humanitarian logistics, infectious disease research and international humanitarian advocacy.Chapters00:00 – Introduction: Meet John Crofts, emergency nurse and humanitarian advocate.00:46 – Nursing at San Francisco General: Working in a Level I trauma centre.02:10 – Violence and Burnout in Emergency Departments: A pilot programme addressing patient agitation and healthcare worker wellbeing.04:14 – When Violence Compromises Critical Care: How competing demands divert resources from critically ill patients.06:19 – Healthcare Violence and Ebola: Parallels between American emergency departments and humanitarian responses in resource-limited environments.08:38 – When Patients Lose Trust in Healthcare: Inequality, frustration and violence against healthcare workers.09:20 – Why Study Austere Medicine?: John's interest in CoROM and international humanitarian medicine.10:16 – Humanitarian Logistics and Advocacy: Learning from clinicians working in Somalia, Ukraine and other challenging environments.11:20 – The ICARE Experience in Malta: What John gained from the course.12:19 – Learning from Other Clinicians: Scenario-based training, shared experience and challenging clinical assumptions.14:31 – Bringing Austere Medicine Back to San Francisco: Why experienced emergency nurses can benefit from resource-limited training.16:56 – Gunshot Wounds Outside the Hospital: When critical care begins on the street with minimal resources.18:28 – An Unconventional Journey into Nursing: How John found his way into healthcare.19:15 – From Helicopter Pilot to Humanitarian Logistics: Aviation, maritime operations and the importance of logistics.20:41 – Nursing Education in Micronesia: Training at a hospital in Palau.23:00 – Refugee Advocacy in Palau: Working with displaced Uyghur former Guantánamo detainees.24:00 – Clearing Explosive Remnants of War: Humanitarian demining and environmental hazards in the Pacific.25:20 – From Alaska to Austere Medicine: How John's experiences shaped his clinical and humanitarian interests.26:55 – Studying Infectious Disease: The London School of Hygiene & Tropical Medicine and global health research.27:30 – Sierra Leone After Ebola: Questions about outbreak preparedness and the sustainability of international aid.28:51 – What's Next for John?: Returning to humanitarian work and strengthening healthcare systems.30:00 – Bioethics and Global Health: Ethical challenges involving technology, resource allocation and healthcare inequality.31:01 – Humanitarian Medicine Beyond Academia: Why practical advocacy remains important.33:26 – Humanitarian Work in Myanmar: Landmines, local communities, political pressures and deportation.35:39 – Research, Publications and Advocacy: Sharing lessons from humanitarian practice.36:28 – Advice for New Austere Clinicians: Following an unconventional career path and embracing uncertainty.38:32 – Compassionate Care in Challenging Systems: Why healthcare professionals must advocate for patients and meaningful change.39:15 – Closing Thoughts: The importance of learning, professional relationships and returning to Malta.

This week, Aebhric O’Kelly catches up with Dmytro following his graduation from CoROM’s BSc in Remote Paramedic Practice and his successful registration as a paramedic with the UK Health and Care Professions Council (HCPC).Dmytro describes his current work providing medical care on a remote Caribbean island and reflects on previous roles in humanitarian and military medicine in sub-Saharan Africa. He explains why working remotely requires a different clinical mindset—particularly when weather, geography or resources prevent evacuation, and a patient may remain in your care for hours or even days. Chapters00:00 – Welcome Back, Dmytro: From CoROM graduate to HCPC-registered paramedic.00:33 – Remote Medicine in the Caribbean: Providing healthcare for thousands of guests and staff on a private island.01:30 – An ICU on a Remote Island: Ventilation, capnography, laboratory diagnostics, POCUS and advanced monitoring.02:58 – Paramedics Doing Radiography: The expanding role of the remote paramedic.03:18 – From Africa to the Caribbean: Humanitarian medicine, military medicine and remote clinic operations.04:40 – Qualifications for Remote Paramedic Work: How education and operational experience helped Dmytro secure his current position.05:33 – Why CoROM?: Why one year of paramedic education wasn't enough and why Dmytro continued through the full BSc.07:20 – Becoming a UK-Registered Paramedic: Starting the HCPC international registration process.09:27 – HCPC Standards of Proficiency: Demonstrating education, experience, autonomy and clinical competence.11:36 – Lessons from the HCPC Application: Documentation mistakes that can add weeks or months to the process.13:58 – AI, Plagiarism and HCPC Applications: Why applicants need to ensure their submission is genuinely their own work.14:15 – The First HCPC Assessment: Where additional evidence was required.15:58 – Preparing for the Test of Competence: UK clinical guidance, common conditions and targeted preparation.18:17 – UK Law and Paramedic Practice: Consent, safeguarding, mental capacity, resuscitation and verification of death.18:50 – What Happens During the Test of Competence?: Clinical scenarios and assessment by practising NHS paramedics.20:38 – Finally Registered: Completing an eight-month HCPC journey.21:31 – What This Means for CoROM Graduates: Dmytro's pathway as a BSc Remote Paramedic Practice graduate.22:03 – Graduation and the People Behind the Degree: Recognising the instructors and clinicians who shape a paramedic.23:21 – Advice for Future BSc Students: Patience, practical training and making the most of KCMC.25:09 – What Comes After the BSc?: MSc Austere Critical Care, offshore medicine and diving medicine.26:19 – Does Austere Training Change How You Practise?: Why remote medicine requires a different professional perspective.26:39 – Hospital Skills vs Remote Skills: Lessons from military medicine in sub-Saharan Africa.28:29 – When You Cannot Evacuate: Managing patients for hours or days aboard ships and in remote locations.29:40 – What Would Dmytro Do Differently?: More pharmacology, more KCMC and more exposure to ICU practice.30:46 – Hurricanes, No Helicopter and No Boat: Why remote clinicians need critical care skills when evacuation fails.31:40 – Advice for New Austere Clinicians: Learn remote medicine from people who actually work in resource-limited environments.32:45 – Looking Back on the Journey: From student to degree-qualified, HCPC-registered remote paramedic.32:56 – Acknowledgements: Dmytro thanks the CoROM faculty, colleagues and organisations that supported his journey.34:20 – Closing Remarks: Continuing the journey in austere and remote 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