202-A Life in Medicine with Dr Winston de Mello

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.

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.

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.

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

In this episode of CoROM Conversations, Bill Vasios is joined by Dr Bob Dichiera, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University's PA programme. Bob introduces a practical approach to remote orthopaedics built around four questions: Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation? The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated pulse, motor and sensory (PMS) assessment before and after interventions. Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise. The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments.