This week, Aebhric O'Kelly speaks with Travis about 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.

This week, Aebhric O'Kelly is joined by Professor Mark Hannaford, founder and CEO of World Extreme Medicine, to discuss the evolution of expedition medicine, humanitarian response, and the growing importance of prolonged casualty care in modern conflict.

From kayaking in Patagonia and Antarctica to developing one of the world's leading extreme medicine organisations, Professor Hannaford shares the experiences that shaped his career and explains how World Extreme Medicine has become a global leader in expedition medicine education, research and humanitarian training.

About the Speaker

Professor Mark Hannaford is the Founder and CEO of World Extreme Medicine (WEM), an organisation dedicated to advancing healthcare in remote, austere and expeditionary environments.

Topics Covered

• Professor Hannaford's journey into expedition and extreme medicine
• The origins and philosophy of World Extreme Medicine
• Why expedition medicine is about far more than trauma care
• The importance of primary care in remote environments
• Developing multidisciplinary expedition medical teams
• Breaking down barriers between military, humanitarian and civilian medicine
• Lessons learned from humanitarian work in Ukraine
• Training civilians in Stop the Bleed and emergency trauma care
• The growing importance of Prolonged Casualty Care in modern warfare
• How drone warfare is changing casualty evacuation
• Creating the MSc in Extreme Medicine at the University of Exeter
• Why research is essential for advancing austere medicine
• Advice for clinicians interested in expedition medicine
• The importance of mastering the basics before deploying
• Building experience through events, rescue organisations and outdoor medicine
• The future of extreme medicine and global medical education

Chapters

00:00 – Introduction

Introducing Professor Mark Hannaford

Correct pronunciation and welcome

00:36 – Mark's background

From geographer to expedition leader

Living in Abu Dhabi

A lifetime in expedition and remote medicine

02:02 – Supporting Ukraine

The origins of the World Extreme Medicine Fund

Choosing a focused humanitarian mission

Current work in Ukraine

04:43 – Adventures in British Columbia

Kayaking with orcas

Patagonia expeditions

Antarctica and the Arctic

Wildlife and expedition life

09:56 – How World Extreme Medicine began

Early expedition medicine

Standardising expedition medical support

Paying expedition medics

Building multidisciplinary teams

15:04 – Breaking down medical silos

Why WEM became World Extreme Medicine

Bringing together military, humanitarian, wilderness and expedition medicine

The evolution of the WEM Conference

17:47 – Medicine beyond medicine

Expedition skills

Bushcraft

Vehicle safety

Risk management

19:17 – Primary care versus trauma

The reality of expedition medicine

Why prevention matters

20:29 – The WEM Fund in Ukraine

Medical supply convoys

TCCC and Stop the Bleed

Training civilians

Building local capability

27:44 – Prolonged Casualty Care

Changing battlefield realities

Drone warfare

Extended evacuation times

Adapting PCC education to frontline needs

30:03 – Sharing Ukraine's lessons

Teaching civilians

NATO exercises

Disseminating battlefield medical lessons

32:27 – Creating the MSc in Extreme Medicine

Partnership with the University of Exeter

Professionalising expedition medicine

Research priorities

Translating austere medicine into mainstream healthcare

37:59 – Advice for new expedition medics

Master the basics

Know your limits

Gain domestic experience

Find mentors

Say yes to opportunities

40:36 – Final advice

Prepare for your environment

Listen more than you speak

41:22 – Closing remarks

Reflections on Professor Hannaford's contribution

Final thoughts and thanks

In this episode of CoROM Conversations, Aebhric O'Kelly is joined by Dr Bill Vasios to discuss one of the most overlooked aspects of remote and austere medicine: the intelligent use of over-the-counter (OTC) medications in austere primary care.

Rather than focusing on advanced equipment and prescription drugs, this discussion explores how a carefully selected collection of inexpensive, widely available medications can effectively manage many of the illnesses and injuries encountered in remote, expeditionary, humanitarian and disaster settings.

The conversation emphasises clinical reasoning, careful assessment, conservative prescribing, and making the most of simple interventions before escalating treatment.

Chapters

00:00 – Introduction: Why OTC medicines matter in austere medicine

02:22 – Traveller's diarrhoea

• Assessment
• Oral rehydration
• Loperamide: when to use it (and when not to)

06:54 – Upper respiratory infections

• Symptom management
• Salt-water gargles
• Saline sprays
• When antibiotics are unnecessary

13:34 – Musculoskeletal injuries

• Pain packs
• Diclofenac
• Patient-guided pain management
• RICE and the ice debate

20:45 – Allergic rashes and contact dermatitis

• Hydrocortisone
• Antihistamines
• Oatmeal
• Recognising anaphylaxis

23:02 – Insect bites and stings

• Local treatment
• Cold therapy
• When to escalate care

25:21 – Dehydration

• Oral rehydration
• IV versus oral fluids
• Hydration strategies in the field

29:59 – Heat illness

• Cooling methods
• Field management
• Preventing heat injury

32:15 – Acid reflux in austere environments

• Antacids
• Ginger
• Practical management tips

32:15 – Minor wound care

• Irrigation
• Soap versus antiseptics
• Dakin's solution
• Alcohol and iodine
• Practical wound cleaning

36:45 – Building the ideal austere OTC medical kit

• Essential medications
• Dressings
• Tape
• Water purification
• Splints
• EpiPens
• Multi-use equipment

41:20 – Final discussion, audience questions and wrap-up

The discussion concludes by assembling a practical remote medicine kit, including:

• Oral Rehydration Salts (ORS)
• Paracetamol
• Ibuprofen
• Loperamide
• Antacids
• Oral antihistamines
• Hydrocortisone cream
• Antifungal cream
• Topical diclofenac
• Zinc oxide tape
• Cohesive bandage (Coban/Vet Wrap)
• Saline
• Soap
• Cling film
• Dressings
• Gauze
• Sunscreen
• Water purification equipment
• SAM splints
• EpiPen
• Compact medication organiser (FOLCA)

Key Take-Home Messages

Good assessment should always precede medication.

Oral hydration remains the cornerstone of treating dehydration.

Many common conditions can be managed safely with inexpensive OTC medications.

Every item carried should ideally have multiple uses.

Patient education and involvement improve outcomes.

Simple treatments, applied correctly, are often more effective than complicated ones.

Featured Speakers

Aebhric O'Kelly: Paramedic, educator and Rector of the College of Remote and Offshore Medicine.

Dr Bill Vasios: Physician Associate, educator and specialist in austere and remote healthcare.

Resources Mentioned

World Health Organization Oral Rehydration Solution (ORS)

Wilderness Medical Society clinical practice guidelines

Joint Trauma System Clinical Practice Guidelines (JTS CPGs)

Bristol Stool Chart

Ottawa Ankle Rules

Listen, Learn, Deploy

Whether you're preparing for an expedition, humanitarian mission, offshore deployment or remote clinic, this episode provides practical, evidence-informed advice on building a lightweight, effective medical kit capable of managing the conditions you are most likely to encounter.

This week, Aebhric is joined by Luca Alfatti, an advanced paramedic and co-founder of the World Extreme Medicine Fund, who shares insights from his global medical missions, including recent work in Ukraine and NATO exercises. Discover how adaptable training and international collaboration are transforming emergency medicine in conflict zones.

Chapters

00:00 Introduction to Luca Alfadi and his background

02:10 Luca's journey from expedition leader to advanced paramedic

05:02 Founding of the World Extreme Medicine Fund

06:57 Medical aid efforts in Ukraine during the war

11:59 Training Ukrainian medics in prolonged casualty care

15:59 Challenges of medical resource limitations in conflict zones

20:09 Adapting training to frontline needs and experience levels

25:06 Participation in NATO Vigorous Warrior exercise

27:59 Lessons learned from NATO exercise on prolonged casualty care

31:59 Upcoming publication in the Journal of Special Operations Medicine

35:03 Psychological and societal impacts of war on healthcare workers

38:01 The importance of international collaboration and relationships

39:06 Advice for new medics entering austere medicine

39:50 Closing remarks and future outlook

Keywords

extreme medicine, Ukraine, prolonged casualty care, NATO exercises, medical training, humanitarian aid, expedition medicine, medical innovation, war zones, emergency response

Key Topics

International medical aid in Ukraine

Prolonged casualty care training

NATO Vigorous Warrior exercise insights

Innovations in casualty extraction and treatment

Adapting medical practices to resource-limited settings

The importance of listening to frontline medics

Psychological impacts of war on healthcare workers

Building international medical collaborations

This week, Aebhric O'Kelly speaks with David Stanton, a search and rescue paramedic, former Medic One paramedic, wilderness medicine educator, researcher at the University of Nottingham, and humanitarian medical instructor. David discusses why exceptional basic life support remains the foundation of all advanced medical care, explores innovations from Seattle's renowned Medic One system, shares lessons from Ukraine, and explains his research into prolonged casualty care and medical intelligence.

Chapters

00:00 – Introduction and David Stanton's background

01:00 – The Seattle Medic One system explained

03:00 – Why Seattle achieves exceptional cardiac arrest survival

06:30 – Innovation, research and improving patient outcomes

08:20 – Head-up CPR and evolving resuscitation science

10:00 – Good ALS begins with great BLS

13:00 – Building confident and capable EMTs

17:00 – Should every EMT become an Advanced EMT?

20:30 – Teaching maxillofacial trauma management in Ukraine

23:00 – Learning from Ukrainian combat medicine

27:30 – Teaching wilderness medicine at Nottingham

29:20 – Medical intelligence as an intelligence discipline

32:00 – Rethinking prolonged casualty care

35:00 – Constraint as the foundation of prolonged casualty care

38:30 – NATO's Vigorous Warrior exercise

40:20 – Final advice for new austere medical providers

About the Guest

David Stanton is a search and rescue paramedic with nearly two decades of pre-hospital experience. His career includes service within Washington State's Medic One system, international rescue operations, humanitarian medical education, and research at the University of Nottingham. His current work focuses on prolonged casualty care, medical intelligence, wilderness medicine, and improving healthcare delivery in austere and conflict environments.

Keywords

Seattle Medic One, David Stanton, paramedic, EMT, Advanced EMT, CPR, cardiac arrest, BLS, ALS, wilderness medicine, austere medicine, prolonged casualty care, combat medicine, Ukraine, medical intelligence, NATO, Vigorous Warrior, TCCC, JTS, CoROM Podcast

This week, Aebhric is joined by Fred, who has spent almost four and a half years working in military and military-adjacent medicine in Ukraine, primarily on the forward line of troops (FLOT), with additional experience at casualty collection points and stabilisation points. In this episode, he and Aebhric trace how combat casualty care has changed since 2022: evacuation timelines have stretched from minutes to weeks, wounding patterns have shifted as troop formations disperse to avoid drone strikes, and medics on the ground are being asked to deliver prolonged field care (PFC) far beyond their training. The conversation covers current combat wound pack medications, the phase-out of nalbuphine, tramadol's hepatotoxicity risk in dehydrated patients, the training gap between CLS/CMC-qualified providers, and the disease and non-battle injury (DNBI) burden from leptospirosis to Lyme disease to anthrax that frontline medics are managing largely on their own.

Chapters

00:00 – Introduction and guest welcome

01:00 – Four years of medical experience on the Ukrainian front

02:00 – How drone warfare has changed casualty patterns

03:10 – Evolution of TCCC and prolonged evacuation

04:20 – Changes to battlefield medications and analgesia

06:00 – Ketamine, morphine and tramadol in prolonged casualty care

08:00 – The challenge of prolonged pain management

09:15 – Nerve blocks and expanding combat medic skills

10:15 – Closing the knowledge gap for frontline medics

12:00 – Self-directed learning and educational resources

13:15 – Current medical training available in Ukraine

15:00 – Could prolonged casualty care become a formal certification?

16:00 – A day in the life of a frontline combat medic

18:15 – Drone casualty evacuation: promise and limitations

20:00 – What knowledge do combat medics really need?

22:00 – Disease, dehydration and prolonged field medicine

23:20 – Final advice for new austere medical providers

Evolving battlefield medicine. Evacuation that once happened within minutes from positions near the front now can take weeks, driven by pervasive drone surveillance and strike capability. Mass casualty incidents near the front line have become less common as units disperse, changing the injury and casualty flow medics have to plan for.

Training and knowledge gaps. There's a wide spread in provider background — from Ukrainian feldshers (registered-nurse equivalent) to personnel who completed a seven-day CMC course — all filling the same frontline medic role. Nerve blocks beyond digital blocks aren't commonly taught. Fred argues CMC training was never meant to stand alone; it assumes a prior EMT-level foundation that many providers don't have. Training availability is inconsistent and largely filled by NGOs of varying quality, with NAMT/CLS/CMC certification currently the closest thing to a standard.

Evacuation reality on the ground. Getting to a casualty may take hours to days depending on drone "weather windows." Waits of 30–60 days for evacuation are not unheard of. As a result, stabilisation points are increasingly seeing patients who would survive regardless of intervention, rather than the critical mid-triage-category patients medics are most needed for. Ground evacuation drones (UGVs) are seeing real use but only for stable patients, since medics can't manage an airway or maintain a sedated patient during transit; aerial casualty evacuation is currently considered infeasible due to drone threats.

Disease and non-battle injury (DNBI). Fred and Aebhric discuss the need for a Ukraine-specific DNBI framework and better environmental/threat updates reaching medics in the field.

Closing advice. Fred's advice for new medics, nurses, and physicians entering austere medicine: keep learning and keep developing — people are counting on you to do your job well.