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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June 12, 2026Episode 19959 min
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.Chapters00:00 – Introduction to Snake Envenomation01:45 – Why Snake Bites Matter in Austere Medicine04:00 – Snakebite Myths and Immediate First Aid05:00 – The Four Envenomation Syndromes08:00 – Operational Planning and Antivenom Selection11:20 – Understanding the JTS Treatment Algorithms16:00 – Case Study: Pit Viper Envenomation22:00 – Determining When Antivenom Has Worked24:00 – Antivenom Dosing Principles26:00 – Field Diagnostics and Coagulopathy Assessment28:00 – Neurotoxic Snake Bites and Respiratory Failure33:00 – Why Identifying the Snake Often Doesn't Matter34:00 – Dry Bites and Return-to-Duty Decisions36:00 – Antivenom Reactions and Anaphylaxis Management39:00 – Tourniquets, Pressure Bandages, and Controversies46:00 – Life Over Limb? Risk-Benefit Decision Making51:00 – Airway Management in Neurotoxic Envenomation55:00 – Regulatory Challenges and Deployment Considerations57:45 – Key Take-Home Messages
June 5, 2026Episode 19835 min
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. Chapters00:00 – Introduction01:06 – Can Non-Medics Learn Ultrasound?03:00 – Lessons from the APUS Course05:30 – The Power of Home Points07:50 – What is Tactical APUS?10:00 – Adapting eFAST for Combat Operations12:30 – Hypothermia Prevention During Ultrasound15:20 – The Controversial Change: Heart Last20:00 – PLAX vs Subxiphoid Cardiac Views24:40 – Teaching Maltese Nurses29:10 – Should We Teach Ultrasound to Combat Lifesavers?32:20 – Ultrasound as a Triage Tool35:10 – Advice for Future Tactical Ultrasound Providers38:00 – Closing RemarksKey TakeawaysThe 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.
May 29, 2026Episode 19722 min
197-Poland PFC with Eagle-Med Systems
This week, Aebhric O’Kelly is joined by Robert Jędrych, a Polish tactical medicine instructor and founder of the Eagle Med System, who appears on the CoROM Podcast to discuss the evolution of tactical medicine and prolonged field care (PFC) training in Poland and Central Europe. Drawing from more than two decades of experience as a paramedic and tactical medicine educator, Robert shares insights into the realities of preparing civilian and military medical personnel for austere and conflict-adjacent environments. The discussion explores the growing demand for prolonged casualty care education due to the ongoing war in Ukraine, the limitations of current civilian tactical medicine pathways, and the importance of realistic scenario-based training. Robert also reflects on his first attendance at the Special Operations Medical Association Scientific Assembly conference and outlines his vision for the future of tactical medicine education in Poland. Chapters• 00:00 – Introduction to Robert Jędrych and his background in tactical and austere medicine • 02:20 – Launching the first Austere Emergency Care (AEC) programme in Poland • 03:40 – Why prolonged field care training is increasingly important in Eastern Europe • 04:40 – Medical support and casualty flow from Ukraine into Poland • 05:10 – Building Eagle Med System and tactical medicine education in Poland • 05:45 – Civilian TCCC versus TECC: the confusion in tactical medicine education • 07:30 – Why TECC lacks a Combat Medic/Corpsman equivalent pathway • 11:15 – Discussion on developing an advanced TECC training framework • 14:50 – The impact of prolonged field care and AEC training on operational readiness • 16:20 – What is missing from current tactical medicine training programmes • 17:20 – The importance of realistic scenarios, stress inoculation, and live tissue/cadaver training • 20:50 – Lessons learned from prolonged field care scenarios and provider fatigue • 21:00 – Attending the Special Operations Medical Association Scientific Assembly conference for the first time • 23:05 – Robert’s five-year plan for tactical medicine and PFC development in Poland • 25:00 – Advice for new medics entering austere and tactical medicine • 27:10 – Final thoughts and future collaboration Key Discussion PointsThe Growth of Austere Emergency Care in PolandRobert discusses implementing the first AEC programme in Poland and the growing recognition that prolonged casualty care requires far more than procedural medicine. Topics include leadership, communication, patient monitoring, documentation, and decision-making in hostile and resource-limited environments. Civilian Tactical Medicine and the TECC GapThe episode examines the disconnect between civilian tactical medicine needs and current educational pathways. While TCCC remains widely recognised, Robert and Aebhric discuss the absence of a TECC equivalent to the Combat Medic/Corpsman pathway and the need for advanced civilian tactical medical training. Realistic Scenario TrainingRobert emphasises that high-fidelity scenarios, environmental stress, fatigue, noise, and realistic casualty simulation are essential for preparing providers to function under pressure. He highlights the importance of moving beyond classroom mannequin training into operationally relevant simulation. Lessons from UkrainePoland’s proximity to the war in Ukraine has shaped the urgency of tactical medicine education. Robert explains how exposure to real-world casualty care challenges has reinforced the need for prolonged field care training among both military and civilian healthcare providers. Building the Future of Tactical MedicineRobert outlines his vision for creating a dedicated training centre, expanding international partnerships, and building a stronger community of instructors capable of teaching evidence-based medicine grounded in operational realities.
May 22, 2026Episode 19632 min
196-MSIW and Guerrilla Medicine with Antonio from EuroMedics
This week, Aebhric O’Kelly is joined by Antonio from European Medics to discuss his first experience attending the Special Operations Medical Association Symposium, the growing importance of Medical Support to Irregular Warfare (MSIW), and how civilian and military healthcare systems must integrate to prepare for future conflicts and disasters. Antonio reflects on lessons from occupied Poland, resistance medicine, Ukrainian battlefield realities, and the importance of resilience, logistics, telemedicine, and improvised medicine in modern austere healthcare systems. Chapters00:00 Introduction and Antonio’s background01:10 First experience attending SOMA03:10 “People over products” in tactical medicine04:30 Civilian involvement in special operations medicine06:50 Key lessons from the MSIW track09:45 What is Medical Support to Irregular Warfare (MSIW)?11:10 Historical resistance medicine in Poland and the Baltics15:00 Underground clinics and covert evacuation chains17:30 Telemedicine in resistance healthcare18:30 How civilian medics can prepare for MSIW21:00 TCCC, JTS CPGs, and tactical medicine education22:00 European Medics Tactical Clinical Operations (TCO) course23:30 Taiwan, resilience, and whole-of-society defence26:20 Logistics and manufacturing challenges in conflict28:40 Relationship building and NATO interoperability29:10 3D printing and improvised medicine31:20 Antonio’s passion for guerrilla medicine34:00 Future plans: anaesthesia, ICU, and flight medicine35:10 Advice for new medics entering austere medicine37:00 Closing remarksEpisode HighlightsFirst impressions from the SOMA SymposiumWhy “people over products” matters in tactical medicineCivilian-military integration in modern conflictWhat MSIW (Medical Support to Irregular Warfare) actually meansHistorical resistance medicine in Poland and the BalticsLessons from Ukraine and occupied territoriesUnderground clinics and covert casualty evacuationTelemedicine and distributed healthcare networksWhy civilian clinicians should learn TCCCLogistics, supply chains, and local manufacturing during war3D printing and improvised medical equipmentThe future of European resilience medicineAdvice for new medics entering austere medicine
May 15, 2026Episode 19549 min
195-Damage Control Procedures with Dr John Quinn
This week, Dr John Quinn joins Aebhric O’Kelly to discuss the emerging field of Damage Control Procedures (DCP) for austere, prolonged, and contested environments.Dr Quinn explores the growing operational gap between Tactical Combat Casualty Care (TCCC) and definitive surgical care, particularly in Ukraine and other high-threat environments where evacuation delays can extend for days. The discussion covers the development of DCP curricula, governance challenges, telemedicine oversight, surgical skills for non-surgeons, and the operational realities driving innovation in prolonged casualty care.The episode also examines lessons learned from Ukraine, the future of austere procedural medicine, and how modern conflict is reshaping medical doctrine across NATO and partner nations. Chapters00:05 – Introduction to Dr John Quinn and current operational work00:39 – Volunteering in Ukraine and advancing damage control resuscitation01:20 – What are Damage Control Procedures (DCP)?02:01 – The gap between TCCC and definitive surgery03:25 – Why delayed evacuation changes medical doctrine04:29 – Surgical skills for paramedics, nurses, and combat medics05:20 – Governance and legal challenges surrounding DCP06:26 – How surgeons may react to DCP concepts07:16 – Telemedicine oversight and surgeon mentorship in austere care09:11 – Surgical expertise shaping the DCP curriculum10:08 – Overview of the DCP programme structure11:16 – Tier 1 skills: surgical airways, thoracostomy, tourniquet conversion, traumatic amputations12:43 – Tier 2 skills: laparotomy, external fixation, fasciotomy, advanced burns14:29 – Tier 3 concepts: burr holes and REBOA15:47 – Future concepts: haemofiltration and advanced austere ICU care18:22 – Why DCP sounds controversial — and why it may still be necessary19:16 – Telemedicine vs autonomous procedural decision-making22:05 – Clinical governance and parallels with paramedic evolution23:38 – Why basic life support remains foundational25:35 – Historical parallels with early paramedic medicine26:36 – Expansion of chest tube and intraosseous use in Ukraine30:11 – What happens next for the DCP pathway?31:24 – The importance of listening to Ukrainian clinicians32:21 – DCP beyond special operations medicine33:32 – Introduction to the Disaster Health Institute (DHI)35:37 – Bridging strategic and operational medicine36:17 – SOF Combat Medical Conference (CMC) discussion38:19 – Upcoming RCSEd webinar on DCP39:30 – Lessons learned from Ukrainian workshops and role-zero care41:40 – Drone warfare, attacks on medical personnel, and evacuation challenges43:18 – Why Ukrainian medics are requesting Tier 1 and Tier 2 DCP capability45:18 – Upcoming DCP workshop at Medicine in the Mediterranean46:31 – Advice for clinicians entering austere medicine50:27 – AI, education, digital twins, and the future of medical contentGuest bioDr John Quinn is an operational clinician, researcher, and educator working across prehospital care, austere medicine, disaster health, and military medicine. Originally trained as a paramedic, he later completed both medical and doctoral training and now works clinically within the United Kingdom while supporting medical projects and training initiatives in Ukraine.Dr. Quinn is involved in the development of Damage Control Procedures curricula and collaborates with international subject matter experts, surgeons, and operational clinicians to improve prolonged casualty care capability in contested environments.Disaster Health Institute is a collaborative network focused on disaster health, operational medicine, epidemiology, humanitarian response, and strategic healthcare preparedness. The organisation works with subject matter experts across Europe, North America, Central Asia, Africa, and South America to develop evidence-informed approaches to modern operational health challenges.
May 8, 2026Episode 19435 min
194-MScACC graduate William Krupa
This week, Aebhric O'Kelly is joined by William Krupa, who recently graduated from the MSc Austere Critical Care programme. They discuss wilderness medicine, tactical medicine education, prolonged field care, and his experience completing the MSc in Austere Critical Care at the College of Remote and Offshore Medicine Foundation.William shares his journey from infantry soldier to paramedic educator, discusses teaching Wilderness First Responder (WFR) programmes, reflects on attending the Medicine in the Mediterranean Conference in Malta, and provides an overview of his MSc thesis on austere mechanical ventilation using portable oxygen concentrators and closed-circuit systems.This episode explores how austere medicine education can reinvigorate clinicians, improve critical thinking, and bridge the gap between theory and operational practice. Chapters00:00 – Introduction to the episode and guest welcome00:41 – William’s current work in paramedicine, wilderness medicine, and tactical medicine education01:20 – Military background and transition into medicine02:30 – Repeating EMT training after military service03:53 – Why repeated teaching improves clinicians and educators05:07 – The value of teaching Wilderness First Responder (WFR) courses07:22 – Deep dives into improvised medicine during longer wilderness courses07:55 – The history of CoROM and how WFR led to degree programmes09:33 – William’s first trip to Malta for APUS and ICARE10:20 – Scenario-based learning and hands-on education at CoROM11:34 – The realism of the ICARE moulage and burn simulations14:05 – Medicine in the Mediterranean Conference experience14:51 – Ukraine battlefield medicine workshop and WPC certification15:40 – Graduation and earning the MSc in Austere Critical Care16:14 – Publishing research and future doctoral plans17:18 – Why William chose the MSc in Austere Critical Care19:23 – What makes CoROM different from other critical care programmes22:16 – Mentorship from MD-PhD faculty and practical education26:08 – William’s MSc thesis on austere mechanical ventilation27:39 – Using oxygen concentrators and closed-circuit systems in austere care29:28 – Research discussion: dual oxygen concentrators and FiO₂ optimisation31:15 – Challenges during the MSc programme33:32 – How the MSc changed William’s clinical practice34:44 – Suggestions for future development of the MSc programme36:47 – Teaching WFR in Utah with Black Swan and Human Path39:01 – Achieving Fellowship of the Academy of Wilderness Medicine (FAWM)41:08 – Why wilderness fellowships carry professional value43:46 – Advice for new medics entering austere medicine45:11 – Closing remarks and congratulations Key Topics • Wilderness medicine education • WMS FAWM • Tactical medicine and TC3 instruction • Prolonged Field Care (PFC) • Austere Critical Care education • Scenario-based simulation training • Improvised medicine • Mechanical ventilation in austere environments • Oxygen conservation strategies • Wilderness medicine fellowships • Medical education mentorship • International austere medicine collaboration Key Takeaways• Scenario-based education improves retention and operational performance. • Wilderness medicine often reignites clinicians’ passion for medicine. • Austere medicine requires adaptability rather than dependence on resources. • International collaboration broadens clinical understanding and perspective. • Practical mentorship from operational clinicians is critical in advanced education. • Mechanical ventilation in austere environments may be feasible with low-resource systems. • Long-form wilderness courses allow deeper exploration of improvised medicine concepts. • Continuous learning is essential for clinicians operating in remote and austere environments.
May 1, 2026Episode 19358 min
193-Severe Malaria Patient Featuring Zach Andrews
This week, Aebhric is again joined by Zach Andrews, who leads the latest episode of CoROM Conversations, which explores the recognition and management of severe malaria in resource-limited and austere environments. Drawing on field-relevant clinical reasoning, the discussion focuses on the progression from uncomplicated to life-threatening disease, with emphasis on Plasmodium falciparum as the primary driver of severe pathology.The conversation highlights the diagnostic challenges faced by remote medics, where laboratory confirmation may be delayed or unavailable, and underscores the importance of clinical pattern recognition, early intervention, and ongoing reassessment. Particular attention is given to complications such as cerebral malaria, severe anaemia, metabolic acidosis, and hypoglycaemia—all of which significantly increase mortality if not rapidly addressed.From a prolonged field care perspective, the episode integrates pragmatic strategies for stabilisation, monitoring, and evacuation decision-making. It reinforces the need for structured patient assessment using frameworks such as CABCDEFGH, along with trending vital signs over time. The discussion ultimately bridges tropical medicine with austere critical care, offering actionable insights for medics operating far from definitive care.Key Learning PointsSevere malaria is a time-critical diagnosis, most commonly associated with Plasmodium falciparum, requiring immediate treatment even before confirmatory testing.Red flag features include altered mental status, respiratory distress, severe anaemia, hypoglycaemia, and shock.Hypoglycaemia is both a complication of malaria and a side effect of treatment (e.g., quinine), necessitating frequent glucose monitoring.In austere environments, clinical diagnosis often precedes laboratory confirmation, requiring high suspicion in febrile patients with travel or endemic exposure.Fluid management must be cautious, balancing the risks of hypovolaemia and pulmonary oedema.Prolonged care requires integration of nursing principles (HITMAN, SHEEP VOMIT) to prevent secondary deterioration.Early administration of parenteral antimalarials (e.g., artesunate where available) is critical to survival.Evacuation planning should be initiated early, but delays must not postpone life-saving interventions.Timestamps00:00 – IntroductionOverview of the case and relevance to austere medicine02:30 – Pathophysiology of Severe MalariaMechanisms of microvascular obstruction and organ dysfunction06:00 – Clinical PresentationRecognising early vs severe disease in the field10:30 – Assessment FrameworksApplying structured approaches (CABCDEFGH, CPRO, BEAST)15:00 – Management PrioritiesAntimalarials, glucose, fluids, and airway considerations20:30 – Complications and MonitoringCerebral malaria, acidosis, anaemia, and respiratory failure25:00 – Prolonged Field Care ConsiderationsNursing care, documentation, and trending30:00 – Evacuation and Decision-MakingWhen and how to move the patient33:00 – Key Takeaways and Closing ThoughtsClinical Pearls / Take-Home MessagesTreat first, confirm later: In suspected severe malaria, delays in treatment increase mortality.Check glucose early and often: Hypoglycaemia can be rapidly fatal and easily missed.Think beyond fever: Altered mental status or respiratory changes may be the first sign of severe disease.Your greatest tool is reassessment: Trends in vital signs are more valuable than single data points.Good nursing care saves lives: Positioning, hydration, hygiene, and monitoring are critical in prolonged care environments.Suggested ReferencesWorld Health Organization. Guidelines for the Treatment of Malaria (latest edition).Joint Trauma System Clinical Practice Guidelines: Prolonged Casualty Care.World Health Organization. Severe Malaria (Tropical Medicine reference standards).White NJ et al. Malaria. The Lancet.
April 24, 2026Episode 19232 min
192-Setting up a Jungle ICU with Zach Andrews
This week, Aebhric O’Kelly is again joined by Zach Andrews, a MSc Austere Critical Care graduate and expert in jungle medicine, who shares his extensive experience in remote critical care, setting up ICUs in challenging environments, and improving medical education. Discover practical tips for medical professionals working in remote areas and learn about innovative approaches to medical training and patient care.Chapters00:00 Introduction and Guest Introduction00:26 Zach Andrews' Background and Current Projects01:06 Role in Student Success Department02:34 Student Program Feedback and Challenges05:50 Faculty and Program Cost-Effectiveness11:27 Setting Up ICUs in Remote and Austere Areas20:42 Importance of Hands-On Assessment in Remote Settings23:00 The Jack of All Trades in Jungle ICU Setup25:18 Lessons from Masters of Austere Care27:33 SOMA Scholarship and Zach's Presentation29:34 Advice for New Medics in Austere Medicine30:52 Closing Remarks and Final Thoughts
April 17, 2026Episode 19133 min
191-AMLS and PHTLS in Pretty Bay, Malta
This week, Aebhric talks with Alfredo Leal, who shares his extensive experience in emergency medical services, including his work with the WHO, offshore rescue missions, and medical training courses like AMLS and PHTLS. Discover valuable insights on pre-hospital care, medical assessment, and the future of emergency medicine training.Chapters00:00 Introduction to Alfredo Leal's Journey01:48 Experiences with the World Health Organisation04:10 Deployment in Ukraine and Its Challenges04:59 Advanced Medical Life Support Course Insights07:43 The Importance of Medical Training12:01 Differential Diagnosis in Pre-Hospital Care16:11 Dynamic Patient Assessment Techniques19:26 Teaching and Training in Emergency Medical Services23:52 Future of Emergency Medical Training27:48 Advice for New Medics in Austere Environments
April 10, 2026Episode 19032 min
190-DHS Graduate Dr Michael Klopper
This week, Aebhric O’Kelly is joined by Dr Michael Klopper, who recently earned his doctorate from CoROM and shares his journey from South Africa to becoming a doctoral candidate in AI, his extensive experience in remote medicine and mountain rescue, and his views on the future of AI in medical research and education. Discover insights on mountain medicine training, AI's role in healthcare, and practical advice for medical professionals in challenging environments.Chapters00:00 Introduction and Dr Klopper's background01:42 Early connection with the College and initial projects04:06 Setting up clinical placements and courses in South Africa05:44 East London clinical work and EMS programs07:28 Dr Klopper's Wilderness Medicine Fellow (FAWM) and future plans11:48 Dr Klopper's PhD thesis on AI in medicine18:19 The importance of search mechanisms and AI in research21:57 Risks and best practices for AI in academic research24:57 Advice for new medical professionals and outdoor enthusiasts28:48 Preparing for deployment in challenging environments29:30 The role of aviation safety and small details in rescue missions32:16 Closing remarks and future plans for Dr Klopper
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