This week, we have another presentation from the Medicine in the Mediterranean conference, held in January 2025. CoROM faculty member Vish Rajan delves into the intricacies of hyperbaric medicine, exploring its history, types of chambers, notable accidents, and the human factors that contribute to safety and efficacy in treatment.

Takeaways

Hyperbaric medicine has a rich history dating back centuries.

Regulations in hyperbarics often arise from tragic accidents.

Different types of hyperbaric chambers serve various medical purposes.

Key accidents highlight the importance of safety protocols.

Human factors play a significant role in hyperbaric treatment outcomes.

Training and proper maintenance are crucial for chamber safety.

Case studies reveal systemic issues in hyperbaric practices.

Communication failures can lead to catastrophic results in emergencies.

Recommendations for improving safety include regular training and audits.

Understanding the risks associated with hyperbaric treatment is essential for practitioners.

Chapters

00:00 Introduction to Hyperbarics and Accidents

02:07 History and Development of Hyperbaric Medicine

04:48 Approved Indications and Misuse of Hyperbaric Therapy

06:28 Types of Hyperbaric Chambers

07:06 Key Accidents in Hyperbaric History

12:28 Case Study: Apollo 1 Incident

18:50 Case Study: Hanover Chamber Incident

25:25 Case Study: Malta Diving Incident

30:00 Analysis of Human Factors in Hyperbaric Accidents

33:02 Recommendations for Safe Hyperbaric Practices

This week, Aebhric O’Kelly talks with Andy Bell, Deputy Director of Paramedicine for St. John's Ambulance in Western Australia, who shares his extensive experience in paramedicine, discussing the evolution of the profession, the role of critical care paramedics, and the challenges faced in remote healthcare settings. He emphasises the importance of academic advancement in paramedicine and the need for a mindset shift towards prolonged field care in austere environments. Bell also provides insights into the future of paramedicine, highlighting the growing role of community paramedics and the integration of evidence-based practices in patient care.

Takeaways

Andy Bell is originally from New Zealand and has extensive experience in paramedicine.

Paramedics in Australia are now registered medical health professionals under APRA.

The critical care paramedics have the most advanced scope of practice in Australia.

There is a significant push for academic advancement in paramedicine.

Evidence-based practice is essential for the future of paramedicine.

Prolonged field care is a common practice in remote areas of Australia.

Communication and coordination are crucial in managing patients in remote locations.

Community paramedics are becoming increasingly important in the healthcare system.

New practitioners should focus on mastering the basics of patient care.

A mindset shift is necessary for effective, prolonged field care.

Chapters

00:00 Introduction to Andy Bell and His Background

03:30 Understanding Paramedicine in Australia

08:15 The Role of Critical Care Paramedics

12:39 The Evolution of Paramedicine and Academia

18:02 The Future of Academic Paramedicine

22:42 Prolonged Field Care in Remote Areas

29:10 Challenges in Patient Management in Remote Locations

35:46 Advice for New Practitioners in Austere Medicine

In this episode of the CoROM Podcast, Dr. Sean Bilodeau discusses the intricacies of pre-hospital medicine, focusing on thoracostomy techniques and the challenges paramedics face in emergency medical services. Through case studies, he highlights the importance of evidence-based practices in needle decompression and the need for improved training methods for paramedics. The conversation emphasises the critical role of paramedics in saving lives and the ongoing efforts to enhance their skills and knowledge in trauma care.

Takeaways

The importance of thoracostomy in pre-hospital settings.

Challenges faced by paramedics in emergency situations.

Case studies illustrate the complexities of needle decompression.

Evidence supports the effectiveness of pre-hospital interventions.

Training methods for paramedics need to be improved.

The role of paramedics is crucial in trauma care.

Understanding the anatomy is essential for successful procedures.

Finger thoracostomy may be more effective than needle decompression.

There is a need for ongoing research in emergency medical practices.

Collaboration between EMS and hospital staff is vital for patient outcomes.

Chapters

00:00 Introduction to Pre-Hospital Medicine

01:28 Understanding Needle Thoracostomy

06:04 Case Studies in Needle Decompression

13:11 Evidence-Based Practice in EMS

21:00 Teaching Techniques for Paramedics

This week, Aebhric O’Kelly talks with Alan O'Brien, OB, who is a paramedic from Ireland with a military background; they discuss his journey from the Irish Army to becoming a paramedic. He shares insights into the evolution of paramedic training in Ireland, the importance of academic pathways for military medics, and the significance of the NATO Special Operations Combat Medic (NSOCM) programme. The conversation also touches on the role of drones in modern combat medicine and the need for standardised medical training across NATO countries. In this conversation, OB discusses various aspects of military medical training, focusing on the NATO SOMT course, the future of the NSOCM programme, and the challenges faced in sustainment training for medics. He shares insights into the Irish Army Ranger Wing and the Nordic programme's impact on medical training. OB also outlines his aspirations for developing a master's programme in security and defence medicine and offers valuable advice for new medics entering the field.

Takeaways

Alan O'Brien is a paramedic with a military background.

He transitioned from the Irish Army to paramedic training.

The paramedic training programme in Ireland has evolved significantly.

Academic pathways are crucial for military medics post-service.

The NSOCM programme standardises medical training across NATO.

Drones are becoming increasingly influential in combat medicine.

The gap between paramedic and advanced paramedic roles is decreasing.

Military medics need academic recognition for their training.

Standardised training improves interoperability among NATO forces.

Understanding modern threats is essential for medical training. The NATO SOMT course is based on the Canadian SOMT program.

SOMTs are support medics skilled in advanced medical techniques.

NSOCM is evolving to include advanced medical skills training.

Time constraints are a significant challenge for medics.

Clinical placements are crucial for maintaining skills.

The Irish Army Ranger Wing was established for counterterrorism.

The unit is modeled on tier one special operations forces.

The Nordic program enhances medical training across countries.

A master's program in security and defence medicine is in development.

New medics should take ownership of their skill set.

Chapters

00:00 Introduction to Alan O'Brien and His Background

02:59 Transition from Military to Paramedic Training

05:56 The Evolution of Paramedic Training in Ireland

08:54 Academic Pathways for Military Medics

12:03 The NSOCCM Program and Its Importance

16:50 The Role of Drones in Modern Combat Medicine

25:47 Understanding the NATO SOMT Course

28:11 The Future of NSACM and Advanced Medical Skills

32:21 Challenges in Sustainment Training for Medics

34:28 Designing an Effective NSOCCM Sustainment Course

41:12 Insights into the Irish Army Ranger Wing

46:07 The Nordic Program and Its Impact

48:20 Future Aspirations and Advancements in Medical Training

52:16 Advice for New Medics and Medical Personnel

This week, we have another Medicine in the Mediterranean Conference speaker from January 2025. Our Vice Dean Eric Bauer talks about the PHACTORS mnemonic for

managing patients in the post-intubation phase, emphasising the importance of understanding and addressing post-intubation hypotension, the role of positive pressure ventilation, and the need for ongoing resuscitation efforts. The discussion highlights various factors that can impact patient outcomes, including the transfer phase and the importance of proactive care in emergency medical settings.

Takeaways

Post-intubation hypotension remains a significant challenge.

The 'Platinum 10' refers to the critical 10 minutes post-intubation.

Positive pressure ventilation can negatively impact haemodynamics.

Hypoxia must be evaluated continuously after intubation.

The transfer phase is often overlooked but crucial for patient care.

Ongoing resuscitation is essential and should not stop after intubation.

Good BLS and ALS care can significantly improve outcomes.

Understanding the patient's history is vital for effective management.

Proactive airway management leads to better patient outcomes.

Continuous education on ventilation techniques is necessary.

Chapters

00:00 Introduction to Post-Intubation Management

01:14 Understanding Post-Intubation Hypotension

03:49 Factors Affecting Post-Intubation Outcomes

10:10 The Role of Positive Pressure Ventilation

14:19 Evaluating Hypoxia and Its Causes

19:15 The Importance of Transfer Phase

23:09 Ongoing Resuscitation and Pharmacology

28:57 Final Thoughts on Post-Intubation Care

This week, Aebhric O’Kelly talks with Dr Matias Nocetto, the Vice President of Divers Alert Network (DAN), who shares his journey from Argentina to becoming a key figure in diving medicine. He discusses DAN's unique operations, the importance of understanding diving-related medical issues, and the challenges faced in diagnosing and treating divers. Dr. Nocetto emphasises the significance of training in diving medicine and offers advice for new medical professionals looking to enter this field.

Takeaways

Dr. Nochetto's journey reflects a lifelong passion for diving and medicine.

DAN serves as a global resource for divers experiencing medical issues.

The hotline operates 24/7, providing critical support to divers worldwide.

Understanding the symptoms and history is crucial for diagnosing diving-related conditions.

Decompression sickness is often misunderstood; cardiac events are a significant risk.

In-water recompression is a controversial practice with many risks.

Training opportunities in diving medicine are available for various medical professionals.

DAN offers CME courses for those interested in diving medicine.

Collaboration and support from the diving community are vital for DAN's mission.

Following one's passion can lead to unexpected and fulfilling career paths.

Chapters

00:00 Introduction to Dr. Matias Nochetto and DAN

02:52 The Journey into Diving and Medicine

10:55 Day-to-Day Operations at DAN

19:47 Understanding Diving Medicine and Decompression Sickness

30:08 In-Water Recompression: Risks and Considerations

36:15 Training Opportunities in Diving Medicine

41:59 Advice for New Medical Professionals in Diving Medicine

This week, Aebhric O'Kelly speaks with Jason Jarvis, a former Special Forces medic and current PhD student, about his experiences in military medicine, the evolution of prolonged field care, and the development of the 'SHEEP VOMIT' mnemonic for patient care in austere environments. They discuss the importance of nursing care, the practical applications of medical knowledge in the field, and the challenges medical practitioners face in remote settings. This conversation delves into critical aspects of patient care, particularly in prolonged field care settings. It emphasises the importance of managing pressure points, understanding vital signs, monitoring core temperature, maintaining oral hygiene, preventing DVT, and ensuring proper input and output monitoring. The discussion also highlights the significance of turning, coughing, and deep breathing for patient recovery, culminating in the legacy of the 'sheep vomit' concept in medical training.

Takeaways

Jason Jarvis has a master's in infectious disease and is pursuing a PhD.

Military experiences shaped his interest in tropical medicine.

Prolonged field care is a systematic approach to patient care in remote settings.

The 'SHEEP VOMIT' mnemonic was developed to aid in prolonged field care.

Skin protection is crucial in austere environments.

Hypothermia prevention is a key focus in field care.

Patient mobility and exercises are essential for recovery.

Checklists help ensure comprehensive patient care.

The evolution of medical mnemonics reflects advancements in field medicine.

Pressure sores develop in specific areas when supine.

Vital signs must be documented and trended over time.

Core temperature is crucial for assessing trauma patients.

Oral hygiene prevents infections that can lead to pneumonia.

DVT prevention is essential for immobilised patients.

Urine output is a key indicator of hydration and health.

Turning and coughing help maintain lung function.

The 'SHEEP VOMIT' concept aids in prolonged field care training.

Training should prepare providers for practical challenges.

Community impact is a goal of medical training.

Chapters

00:00 Introduction to Jason Jarvis

00:46 Jason Jarvis: Background and Current Work

02:37 Military Experiences and Deployments

05:58 Transitioning to Civilian Life and DMI

09:52 Prolonged Field Care: Concepts and Evolution

13:45 Developing the Sheep Vomit Mnemonic

18:35 Understanding the Sheep Vomit Mnemonic

21:58 Practical Applications of Prolonged Field Care

26:12 Exercises and Patient Mobility

29:35 Managing Pressure Points in Patient Care

30:05 Understanding Vital Signs and Their Importance

31:10 The Role of Core Temperature in Patient Assessment

32:40 Oral Hygiene and Its Clinical Significance

36:02 Preventing Deep Vein Thrombosis (DVT) in Immobilised Patients

40:44 Monitoring Input and Output: A Vital Sign

49:04 The Importance of Turning, Coughing, and Deep Breathing

55:00 The Legacy of Sheep Vomit in Medical Training

This week, Aebhric O’Kelly talks with Professor Enrico Brunetti about his extensive experience with ultrasound in infectious diseases and tropical medicine. He shares insights into the evolution of ultrasound technology, its applications in clinical practice, and the importance of education in this field. The discussion also covers the short course he developed at the University of Pavia, the challenges faced in tropical medicine, and advice for new medics interested in ultrasound.

Takeaways

Ultrasound has been a clinical tool since the 1980s.

There are continuous advancements in ultrasound applications.

Training is crucial for effective ultrasound use.

The short course aims to broaden understanding of ultrasound in tropical medicine.

Postgraduate certification is available for online courses.

Ultrasound can diagnose and treat various tropical diseases.

Networking and collaboration are key in medical education.

Challenges in tropical medicine require innovative solutions.

Patience is essential for mastering ultrasound skills.

The global movement for ultrasound in emergency medicine is growing.

Chapters

00:00 Introduction to Professor Enrico Brunetti

05:02 The Evolution of Ultrasound in Clinical Practice

10:04 Ultrasound Applications in Infectious Diseases

15:03 The Short Course in Ultrasound and Tropical Medicine from Pavia

19:48 Postgraduate Certification and Online Learning

24:52 Challenges and Opportunities in Tropical Medicine

29:49 Advice for New Medics in Ultrasound Practice