This week, Aebhric O’Kelly is joined by Splinter Knoppert, who is a 2nd-year BSc student attending the Intensive Care for Austere and Remote Environments (ICARE) course in Malta. They discuss his experiences during the week, including the practical skills, teamwork, resource-limited environments, and innovative teaching methods.

Aebhric is then joined by Dr Csaba Dioszeghy, and they discuss the origin of the ICARE course 14 years ago.

Chapters

00:00 Introduction to the ICARE Course in Malta

00:58 BSc Student Splinter talks about his experience in ICARE

02:04 Diverse Participants and Their Backgrounds

02:53 Skills Gained: Ultrasound, Central Lines, and Improvisation

03:47 Blue Time: Practice and Muscle Memory

05:06 Overview of Scenarios: Crush Injuries, Tropical Diseases, and Trauma

05:52 Building a Remote ICU: Key Components and Challenges

06:30 Setting Up an ICU in the Jungle: Precautions and Planning

07:14 Impact on Paramedic Practice and Future Plans

08:16 Introduction to Dr Csaba Dioszeghy and Critical Care Education

09:06 Origins of Critical Care Teaching and Collaboration

10:51 Simplifying Critical Care for Resource-Limited Settings

13:07 Development of the MSc in Critical Care

14:29 Teaching Principles: Using Critical Care Without Fancy Equipment

15:26 From Aeromedical Transport to Specialised Critical Care Training

16:22 Addressing the Gap in Critical Care Education

16:47 Curriculum Focus: Basic to Advanced Critical Care Concepts

17:43 Teamwork and Non-Technical Skills in Critical Care

18:40 The Importance of Crew Resource Management

20:20 Simulation-Based Training for Teamwork and Skills

21:15 Elective Courses and International Participation

22:10 The Future of the MSc Program and Crew Resource Management

24:04 Technical Skills Practice: Ultrasound, Suturing, and Intubation

24:57 The Value of the iCare Course and Its Evolution

25:50 Upcoming Deep Dive into the Masters of Austere Critical Care

We will have questions about the episode icon, which is a picture of an ancient carving of the Rod of Asclepius. This is on a church outer wall in Mdina, Malta, with origins in the Knights Hospitaler.

This week, Aebhric O'Kelly and Bill Vasios host another CoROM Conversations. This month, they discuss the comprehensive nursing interventions, training strategies, and best practices for prolonged field care, emphasising simplicity, effective handovers, and patient safety.

https://youtu.be/U63NaFLaxZ0

Chapters

00:00 Introduction to Nursing Interventions

00:53 Exploring CPGs and Nursing Interventions

02:25 Comparing Non-Medical and Medical Personnel Guidelines

05:50 Simplifying Nursing Interventions for Non-Medical Personnel

09:05 Wound Care Disparities in Guidelines

11:05 Identifying Gaps in Nursing Care Guidelines

12:07 The Need for Simplified Guidelines

16:15 Importance of Structured Handover

24:03 Trending and Serial Assessment in Patient Care

26:17 Understanding Patient Comfort and Injury Prevention

27:36 The Importance of Hands-On Nursing

28:32 Pressure Injury Prevention Strategies

29:52 Efficient Patient Care Techniques

31:17 Pain Management in Nursing

33:12 Pulmonary Hygiene and Patient Mobility

35:14 Nutrition and Hydration in Patient Care

35:37 The Role of Checklists in Medical Practice

41:33 Infection Prevention and Wound Care

43:34 Final Thoughts on Patient Care Practices

44:01 Any Questions?

This week, Aebhric is joined by Dr Harrison Steins, who is finishing his MSc in Austere Critical Care with CoROM. He also finished medical school and is starting his emergency medicine training. His master’s thesis was on the complexities of swimming-induced pulmonary oedema (SIPE), a rare condition affecting athletes, particularly in high-altitude environments. The speaker, Harrison Steins, discusses the pathophysiology, clinical presentation, diagnosis, and management strategies for SIPE, emphasising the importance of context in medical practice. He shares case studies, research findings, and future directions for understanding and treating this condition, highlighting the role of ultrasound in diagnosis and the need for tailored prevention strategies.

Takeaways

Swimming-induced pulmonary oedema is a rare condition with a prevalence of less than 1%.

Understanding the context of patient presentation is crucial for diagnosis.

Acute-onset cough and dyspnoea are key symptoms of SIPE.

Diagnosis requires a broad differential, ruling out other conditions first.

Management focuses on immediate life threats before addressing SIPE.

Hydration strategies can prevent SIPE, especially in athletes.

Sildenafil may be effective in preventing SIPE, but it is not widely recommended.

Handheld ultrasound is a reliable tool for diagnosing pulmonary oedema in the field.

Females may have a higher incidence of SIPE at lower elevations than males do.

Knowledge of population-specific pathology is essential for effective treatment.

Chapters

00:00 Introduction to Swimming-Induced Pulmonary Oedema

04:47 Understanding the Pathophysiology of Swimming-Induced Pulmonary Oedema

09:18 Case Studies and Clinical Presentation

13:48 Diagnosis and Imaging Techniques

19:26 Management Strategies and Treatment

24:17 Research Findings and Future Directions

This week, Aebhric O'Kelly interviews four students from our BSc in Remote Paramedic Practice programme. They discuss the Tropical Travel and Expedition Medical Skills course (TTEMS).

This week, Aebhric O'Kelly is joined by Dr Ella Corrick, Dr Sean Bilodeau and Dr Tom Mallinson as the CoROM faculty attend The Big Sick conference hosted by Air Zermatt.

CoROM gave three lectures and two workshops including the Improvised Medicine workshop and the Austere Emergency Care workshop.

Takeaways

The challenge of compressing prolonged field care education into short workshops.

Engagement of diverse professional backgrounds enhances learning experiences.

Realistic simulations provide valuable insights into emergency care.

The importance of bridging the gap between pre-hospital and hospital care.

Innovations in emergency medicine practices are crucial for improving patient outcomes.

Data plays a significant role in shaping emergency response strategies.

Continuous education is essential for adapting to new medical practices.

The value of informal discussions among professionals at conferences.

Understanding the unique challenges faced by pre-hospital care providers.

The need for a shift in perception regarding the role of EMS professionals.

Chapters

00:00 Introduction to the Big Sick Conference

02:34 Challenges in Prolonged Field Care Education

05:43 Diverse Professional Backgrounds in Medical Education

08:09 Learning Through Realistic Simulations

11:04 Bridging the Gap Between Pre-Hospital and Hospital Care

13:39 Innovations in Emergency Medicine Practices

16:46 The Role of Data in Emergency Response

19:10 Future Directions in Pre-Hospital Care

21:39 Conclusion and Reflections on the Conference

This week, we hear from Burjor Langdana, who runs the Wilderness and Expedition Dentistry workshop for CoROM. Burjor discusses the management of dental pain, focusing on assessing sensitivity, identifying causes, and evaluating treatment options. It emphasises the importance of patient care, oral hygiene, and antibiotic use in the management of dental conditions. The discussion also covers cultural considerations and improvisation in emergency situations, providing valuable insights for dental practitioners.

https://wildernessdentistry.com/

Takeaways

Understanding the characteristics of dental sensitivity is crucial.

Location and duration of pain are key indicators.

Aggressive brushing can lead to gum recession and sensitivity.

Clove oil can be effective but should be used cautiously.

Flossing is essential to prevent food buildup and gum irritation.

Antibiotics may be necessary for managing infections.

Improvisation is important in emergency dental care.

Cultural beliefs can impact patient care and treatment acceptance.

Communication with patients about procedures is vital.

Managing expectations regarding treatment outcomes is essential.

Chapters

00:00 Introduction to Managing Dental Pain

00:57 Understanding Sensitivity: Duration and Location

06:32 Identifying Causes of Sensitivity

12:12 Managing Sensitivity with Home Remedies

12:40 Addressing Food-Related Pain

18:37 Techniques for Filling Cavities

29:11 Improvising Without Instruments

29:39 The Role of Salt Water in Oral Health

34:53 Managing Tooth Pain and Food Impaction

39:06 Understanding Fillings and Their Complications

45:42 Gumboils: Causes and Management

49:48 Skills for Remote Dental Care

56:04 Cultural Sensitivity in Dental Treatment

This week, Aebhric O’Kelly is again joined by Dr Sam Slishman. They discuss medical innovation and Aebhric’s invention called the AirBase. They discuss medical innovation, focusing on inventions, such as the Slishman Traction Splint and the Airbase. They emphasise the importance of evidence-based medicine, particularly in the use of tourniquets and bleeding control techniques. The discussion also addresses the challenges of marketing medical devices, the role of 3D printing in healthcare, and advice for aspiring medical professionals in austere environments.

Takeaways

Innovations in medical devices can significantly impact patient care.

Tourniquets are effective but should be used with caution.

Direct pressure is often more effective than tourniquets for certain injuries.

The Airbase serves multiple purposes during emergencies.

3D printing can revolutionise medical device development.

Standard of care is not static and can vary by location.

Patient comfort is crucial in emergency medicine.

Research in austere medicine faces unique challenges.

Continuous learning and adaptation are essential for medics.

Chapters

00:00 Introduction to Dr Sam Slishman

01:31 Innovations in Medical Devices

04:25 Tourniquet Efficacy and Research

09:38 Direct Pressure vs. Tourniquets

17:50 The Airbase: A New Medical Tool

24:14 Challenges in Medical Device Development

31:20 The Role of 3D Printing in Medicine

39:19 Advice for Aspiring Medics

This week, Aebhric O’Kelly is joined by Rabbit, who is an EU SOF medic who shares his extensive background in military medicine and his current focus on researching the effects of higher education on individuals with PTSD. He discusses his personal experiences with PTSD and how education has played a role in his recovery. The conversation also touches on the importance of engaging the younger generation in military medicine, adapting to the changing battlefield, and the need for collaboration between special operations and conventional forces. Rabbit emphasises the significance of education and teamwork in improving outcomes for those affected by trauma.

Takeaways

Rabbit has a rich background in military medicine and education.

His PhD research focuses on PTSD and higher education.

Education can provide hope and support for individuals with PTSD.

There is a need for specialised programs for military personnel with PTSD.

Engaging the younger generation is crucial for the future of military medicine.

Collaboration between special operations and conventional forces is essential.

Rabit emphasises the importance of teaching and enabling others in medicine.

The battlefield is evolving with new technologies and challenges.

Personal experiences with PTSD can inform research and treatment.

Teamwork is vital in prolonged field care situations.

Chapters

00:00 Introduction to Rabbit and His Background

02:52 Exploring PTSD and Higher Education

10:22 Personal Experiences with PTSD and Education

17:12 The Role of SOMA and Engaging the Younger Generation

26:57 Advice for New Medics and Collaboration in Medicine

This week, Aebhric O’Kelly talks with Zach Andrews, a SOF medic, to discuss his journey through the MSc in Austere Critical Care, with a focus on his thesis on microcirculation in resource-limited settings. He shares insights into the challenges and learning experiences of his studies, the development of the AMSS score for assessing microcirculation, and his future aspirations in medicine, particularly in rural EMS and education.

Takeaways

Zach is on active duty in the U.S. Army as a SOF medic.

He works as a critical care paramedic in a rural county.

His thesis focused on microcirculation in resource-limited settings.

He explored noninvasive methods for assessing microcirculation.

Zach developed the mottling score to evaluate microcirculation.

He emphasises the importance of basic medical skills.

Zach plans to pursue a doctorate in the near future.

He aims to validate his Microcirculatory Integrated Severity Scale (AMSS) in real-world settings.

Zach believes in the significance of education in rural healthcare.

He appreciates collaborative problem-solving in medical training.

Chapters

00:00 Introduction to Zach Andrews and His Journey

06:08 Exploring the Master's Program in Osteo-Critical Care

13:20 Thesis Topic: Microcirculation in Resource-Limited Environments

20:24 Developing the Microcirculatory Integrated Severity Scale (AMSS)

24:25 Future Plans and Advice for New Practitioners

This week, Aebhric O’Kelly, Bill Vasios, and Rhod Jordan lead an open discussion examining the critical role of nutrition in prolonged field care. The conversation explores enteral and parenteral feeding modalities, outlining their respective indications, benefits, and practical limitations in austere and resource-constrained environments. Particular emphasis is placed on the value of early nutritional intervention in supporting physiological recovery, including practical techniques for nasogastric tube placement and for identifying and managing feeding-related complications. The discussion further considers the challenges of maintaining nutritional support during patient transport. It highlights the importance of interdisciplinary collaboration, including consultation with nutrition specialists, to develop safe and effective nutritional care plans.

Takeaways

Nutrition is crucial in prolonged field care.

Enteral nutrition is less invasive and safer.

Early feeding improves healing and recovery.

Consult a nutritionist for feeding plans.

NG tubes can reduce complications in feeding.

Monitor for complications during feeding.

Parenteral nutrition may be necessary in some cases.

Feeding techniques can vary based on patient condition.

Understanding nutritional needs is essential for care.

Future discussions will focus on advanced topics.

Chapters

00:00 Introduction to Prolonged Field Care and Nutrition

02:40 Understanding Enteral and Parenteral Nutrition

04:53 Benefits of Early Nutritional Support

07:47 Indications and Contraindications for Feeding

09:32 Practical Considerations for Feeding in Austere Environments

11:51 Calculating Nutritional Requirements

14:30 Challenges in Nutritional Support During Transport

17:16 Techniques for NG Tube Placement

20:00 Monitoring and Managing Feeding Complications

22:19 Discussion on Parenteral Nutrition

24:41 Conclusion and Future Topics