Hosted by Aebhric O'Kelly, a critical care paramedic and former Green Beret, CoROM Cast explores wilderness medicine, austere healthcare, tropical diseases, emergency medicine, and remote medical practice. Weekly discussions feature global experts on Prolonged Field Care, Austere Critical Care, disaster medicine, humanitarian response, military pre-hospital care, tropical medicine, expedition healthcare, medical innovation, and practical solutions for healthcare in resource-limited environments.
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This week, Aebhric O’Kelly welcomes Marlon Flanders, a paramedic from Trinidad and Tobago and MSc in Austere Critical Care student at CoROM.
After 13 years in ambulance services, Marlon has transitioned into offshore medicine, providing healthcare aboard oil and gas installations and deep-sea pipeline vessels in the Caribbean. He discusses the challenges of moving from urban emergency medical services into an environment where primary care, logistics, occupational health and evacuation planning become essential responsibilities.
The conversation explores the development of paramedicine in Trinidad and Tobago, including clinical scope of practice, international certification, advanced paramedic education and the challenges of maintaining consistent professional standards across national borders.
Marlon reflects on his experience completing the MSc in Austere Critical Care, including practical ultrasound training in Malta, and explains how postgraduate education has helped him adapt to the demands of remote healthcare.
Chapters
00:00 – Opening hook: Offshore versus urban paramedicine 00:15 – Welcome to CoROM Conversations 00:44 – Introducing Marlon Flanders 01:03 – Thirteen years in EMS and transitioning to offshore medicine 02:08 – Logistics and primary care aboard offshore installations 02:57 – How the MSc in Austere Critical Care supports offshore practice 03:26 – Practical ultrasound training in Malta 04:19 – Ultrasound and offshore evacuation decisions 05:13 – BOSIET, STCW and offshore safety training 06:04 – Paramedic education and registration in Trinidad and Tobago 06:38 – International certification and employment opportunities 07:33 – Professional registration and the International Paramedic Registry 08:30 – Flight and critical care paramedic certification 09:34 – Completing paramedic training in Trinidad and the United States 11:10 – Clinical autonomy and paramedic scope of practice 12:04 – Sedation, analgesia and multimodal pain management 12:41 – Ambulance transport times and rural healthcare access 13:52 – Helicopter medical evacuation between Trinidad and Tobago 14:33 – Trauma facilities and specialist hospital services 15:25 – Common medical and traumatic emergencies in Caribbean EMS 16:12 – Stroke recognition and barriers to timely thrombolysis 16:45 – Public education, bystander CPR and dispatcher-assisted resuscitation 17:53 – Opportunities to improve community emergency response 18:16 – MSc research into non-emergency ambulance utilisation 18:41 – Community paramedicine and advanced clinical practice 19:33 – Why Marlon chose the MSc in Austere Critical Care 20:22 – Reflections on postgraduate education and transitioning careers 21:34 – Diving medicine and further offshore medical qualifications 23:03 – Redesigning ambulance deployment across Trinidad and Tobago 24:05 – Future ambitions in Caribbean and international medicine 24:21 – Humanitarian medical opportunities in Haiti 25:17 – Preparing for healthcare delivery in challenging security environments 26:48 – Advice for clinicians entering austere medicine 27:00 – Persistence, adaptability and overcoming professional barriers 28:01 – Final reflections and closing remarks
Paramedicine in Trinidad and Tobago
Offshore medicine and occupational healthcare
Transitioning from urban EMS to remote practice
Primary care in resource-limited environments
International paramedic registration and certification
219-Wilderness & Rescue EMS in Iceland with Axel Višarsson
Season 5 · Episode 219
Friday, October 30, 2026 • Duration 37:47
This week, Aebhric O'Kelly speaks with Axel Ernir Viðarsson, an advanced EMT, firefighter and search and rescue instructor based in Akureyri, northern Iceland.
With more than 20 years of volunteer search and rescue experience, Axel offers fascinating insight into Iceland's emergency medical services, wilderness rescue operations, and the challenges of delivering prehospital care in one of Europe's most geographically demanding environments.
Chapters
00:00 – Introduction to Axel Ernir Viðarsson
01:18 – Rescue 26: Iceland's International Search and Rescue Conference
03:27 – Bringing Prehospital Ultrasound to Iceland
05:39 – The Future of POCUS in Icelandic Ambulance Services
07:15 – Firefighting, Ambulances and Fixed-Wing Air Evacuation
09:55 – What Is a Smoke Diver?
11:34 – How Iceland's EMS and Search and Rescue Systems Work Together
13:26 – Volcanic Eruptions and Search and Rescue Operations
16:29 – Tourist Rescues, Blizzards and Wilderness Emergencies
17:56 – Iceland's Paramedic Education and Overseas Training
19:41 – Designing the Ideal Icelandic EMS System
21:22 – Advanced EMT Training in Iceland
24:44 – Could CoROM's BSc Remote Paramedic Practice Work in Iceland?
27:17 – Prolonged Patient Care in Iceland's Remote Wilderness
29:32 – Coordinating EMS, Search and Rescue and Air Ambulance Evacuation
32:29 – Choosing Between Akureyri and Reykjavík Hospitals
33:26 – When the Patient Is Nothing Like the Dispatch Report
218-Austere Medicine in a Level One Trauma Centre
Season 5 · Episode 218
Friday, October 23, 2026 • Duration 37:54
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.
Chapters
00:00 – Introduction: Meet John Crofts, emergency nurse and humanitarian advocate.
00:46 – Nursing at San Francisco General: Working in a Level I trauma centre.
02:10 – Violence and Burnout in Emergency Departments: A pilot programme addressing patient agitation and healthcare worker wellbeing.
04:14 – When Violence Compromises Critical Care: How competing demands divert resources from critically ill patients.
06:19 – Healthcare Violence and Ebola: Parallels between American emergency departments and humanitarian responses in resource-limited environments.
08:38 – When Patients Lose Trust in Healthcare: Inequality, frustration and violence against healthcare workers.
09:20 – Why Study Austere Medicine?: John's interest in CoROM and international humanitarian medicine.
10:16 – Humanitarian Logistics and Advocacy: Learning from clinicians working in Somalia, Ukraine and other challenging environments.
11:20 – The ICARE Experience in Malta: What John gained from the course.
12:19 – Learning from Other Clinicians: Scenario-based training, shared experience and challenging clinical assumptions.
14:31 – Bringing Austere Medicine Back to San Francisco: Why experienced emergency nurses can benefit from resource-limited training.
16:56 – Gunshot Wounds Outside the Hospital: When critical care begins on the street with minimal resources.
18:28 – An Unconventional Journey into Nursing: How John found his way into healthcare.
217-CoROM BSc to HCPC with Dmytro Vozniuk
Season 5 · Episode 217
Friday, October 16, 2026 • Duration 29:24
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.
216-MSc Student Rob Schembri
Season 5 · Episode 216
Friday, October 9, 2026 • Duration 29:21
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.
Chapters
00:00 – Meet Rob Schembri: Critical care paramedicine, Ornge and joining the special operations team.
01:18 – The Malta Connection: Rob's Maltese heritage and his family's move to Canada.
03:03 – Returning to Malta for a Master's Degree: The irony of pursuing postgraduate education in the country his parents left.
03:25 – Why the MSc in Austere Critical Care?: Preparing for specialist critical care and special operations.
High-risk pathogens, mechanical cardiac support, USAR and specialist transport.
215-BSc Remote Paramedic Practice graduate Kevin Fox
Season 5 · Episode 215
Friday, October 2, 2026 • Duration 40:36
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.
214-Remote Orthopaedics with Dr Bob Dichiera
Season 5 · Episode 214
Friday, September 25, 2026 • Duration 50:12
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.
00:00 – Tuning-fork fracture diagnosis cold open
00:18 – Introduction to Remote Orthopaedics
01:58 – Why MSK injuries matter in remote medicine
03:00 – Orthopaedic emergencies you cannot miss
04:18 – Damage-control orthopaedics
– Is the patient dying? Is the limb dying?
213-From the White House to Ukraine: Lessons in Austere Medicine with Dr Travis Kaufman
Season 5 · Episode 213
Friday, September 18, 2026 • Duration 47:37
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.
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.
212-What makes a paramedic? With David Page
Season 5 · Episode 212
Friday, September 11, 2026 • Duration 41:52
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.
211-CaBAMiquine One Dose Malaria Treatment?
Season 5 · Episode 211
Friday, September 4, 2026 • Duration 29:49
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.
Details about CoROM cast. Wilderness, Austere, Remote and Resource-limited Medicine. , a podcast by College of Remote and Offshore Medicine
34:29 – Axel's Journey into Search and Rescue
37:06 – Becoming a Wilderness Medicine Instructor
38:54 – Teaching, Avalanche Rescue and Wilderness First Aid
40:11 – Why Austere Medicine Makes Better Clinicians
41:21 – Learning from Students and Fellow Instructors
42:32 – Advice for New Austere Medicine Practitioners
43:38 – Getting Involved in Conferences and Professional Education
44:26 – Final Thoughts and Future CoROM Training in Iceland
Topics Discussed
- Icelandic emergency medical services and advanced EMT practice
- Volunteer search and rescue and the Icelandic Association for Search and Rescue (ICE-SAR/ISAR)
- Volcanic eruptions, avalanche rescue and wilderness emergencies
- Fixed-wing air ambulance operations and Coast Guard helicopter evacuation
- Prolonged field care and remote patient transport
- Point-of-care ultrasound in prehospital medicine
- Advanced EMT and paramedic education pathways
- International collaboration in remote paramedic education
- Wilderness medicine instruction and professional development
- The importance of networking, conferences and lifelong learning
19:15 – From Helicopter Pilot to Humanitarian Logistics: Aviation, maritime operations and the importance of logistics.
20:41 – Nursing Education in Micronesia: Training at a hospital in Palau.
23:00 – Refugee Advocacy in Palau: Working with displaced Uyghur former Guantánamo detainees.
24:00 – Clearing Explosive Remnants of War: Humanitarian demining and environmental hazards in the Pacific.
25:20 – From Alaska to Austere Medicine: How John's experiences shaped his clinical and humanitarian interests.
26:55 – Studying Infectious Disease: The London School of Hygiene & Tropical Medicine and global health research.
27:30 – Sierra Leone After Ebola: Questions about outbreak preparedness and the sustainability of international aid.
28:51 – What's Next for John?: Returning to humanitarian work and strengthening healthcare systems.
30:00 – Bioethics and Global Health: Ethical challenges involving technology, resource allocation and healthcare inequality.
