207-OTC Drugs for Austere Primary Care
CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.Show Notes
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.
More from CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.
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. Chapters 00:00 – 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.
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