210-Lessons from Northern Sweden and Ukraine
CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine.Show Notes
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.
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.
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.
This week, Aebhric O'Kelly speaks with Dr Travis Kaufman and they explore 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.