World Extreme Medicine Podcast

Welcome back to the World Extreme Medicine podcast. Today we have a fascinating conversation with Scott King, a highly experienced paramedic and instructor. He has trained individuals in hostile environments around the world with NGOs and militaries.

We delve into the challenges of preparing teams for these demanding conditions. Scott shares insights on effective training approaches, drawing on his vast experience. He highlights tailoring the training to the audience, incorporating high realism through simulations, and the power of kinaesthetic learning.

Topics include:

• The mixed effectiveness of past trainings
• Differing expectations of military vs NGO participants
• Fidelity concepts for impactful learning
• Benefits of high realism in live scenarios
• Challenges instructors face with language barriers and knowledge transfer
• The growth of simulation training and the role of facilitators
• Key elements like safety, mission planning, and muscle memory

If you want to learn more about operating in hostile environments, be sure to check out our new Hostile Environments Medicine course. It's the perfect way to gain crucial hostile medical skills following Scott's insights.

In this episode we will look at the benefit and utility of Methoxyflurane, more commonly known as Penthrox. Penthrox is a volatile, self-administered inhalation analgesic indicated for short-term pain relief. Penthrox is a portable, lightweight, non-invasive inhaler for self-administration of the Methoxyflurane vapor. The Methoxyflurane vapour provides analgesia when inhaled at low concentrations. At analgesic therapeutic doses, pain relief can reduce and mitigate even severe pain yet has a short half-life. In this episode I will be speaking to Will about it’s use and limitations within the expedition environment and how and when it can be optimally used as either a sole adjunctive pain relief agent or as part of a larger pain relief strategy.

Will is our Joint Medical Director and provides clinical oversight for all World Extreme Medicine’s activities. Will is a jobbing Devon based GP, educator and adventure addict who thrives in wild places with newly formed teams and limited resources.

He has provided medical cover for dozens of very different expeditions and projects; including commercial high-altitude treks in The Himalayas and The Andes, a luxury Trans-Siberian private train, a reality TV show in the South Pacific and he has worked with UNICEF out in forgotten corners of Myanmar.

We speak to some of the most extreme medics in some of the world's most remote locations, due to this there can sometimes be an issue with sound quality, so there are a few quality dips in this episode, but we felt it was an important conversation to share.

Welcome back to the podcast that explores the exhilarating world of extreme medicine. In today's episode, we delve into the impact of PTSD and PTSI on individuals in high-stress professions like the military. Boxxy shares personal experiences and insights, emphasising the importance of acknowledging emotional trauma and fatigue and the need for early intervention and open communication about mental health. Join us as we uncover the evolving landscape of military medicine, survival training in extreme environments, and the rewarding nature of saving lives. Stay tuned for an adventurous journey into the world of extreme medicine.

On this episode, our guest Klara Weaver talks about Wedel seals farting in her face in Antarctica, peeing in a Nalgene in the middle of the night (and the need to practice in the shower), sexism in expedition medicine, the role of social media in expedition medicine self promotion and keeping it grounded, the importance of ‘mentally’ unpacking after expedition, shout out to our supportive family friends and partners who put up with us! And her love affair with grass post Antarctica. 

We also discuss the allure of buying new kit for hobbies and how it has inspired her side hustles. Klara shares her passion for arts and crafts, being outdoors, and her interest in business and small businesses. Klara also talks about her foray into carpentry and making things with power tools when converting a campervan. During her time in Antarctica, Klara learned crochet as a distraction and a way to quiet her mind. She emphasises the importance of having something outside of medicine, whether it's a hobby, sport, or other skill. Klara believes that having a side hustle can bring valuable skills back into medicine and make it more interesting. She mentions the potential for quality improvement projects in medicine inspired by business practices. Having diverse interests makes one a more well-rounded doctor and makes the less exciting aspects of medicine more enjoyable. Klara shares that her family and friends have a short attention span when it comes to her experiences in Antarctica. She highlights that people often want her 20-month expedition to be condensed into a few sentences, not fully understanding the challenges and intensity of the experience. She warns that social media can give a misleading perception of expeditions, emphasizing the behind-the-scenes work, anxiety, and potential risks involved.

In this episode, we sit down with Dr. Shawn Rowland, a Hawaiian physician who stepped onto the frontlines of the intense Lahaina fire disaster. Dr. Rowland, a board-certified Family Medicine physician and the founder of Jase Medical, brings a unique perspective to the challenges of disaster response. With a background that spans rural and critical access hospitals, as well as international medical work in Mexico and across the United States, Dr. Rowland's experiences are both diverse and impactful. However, it's his involvement in search and rescue that truly sets him apart. Starting with his EMT days at the University of Utah, where he served for six years with the Salt Lake County Sheriff’s Search and Rescue Team, he's honed skills that range from Mountain Rescue to Swift Water Rescue. Currently residing on the tranquil north shore of Oahu, Hawaii, alongside his family, Dr. Rowland's insights into the Lahaina fire disaster are both personal and professional. Join us as we explore his journey through the chaos, his unwavering commitment to saving lives, and the unique challenges that come with responding to a disaster of this magnitude. Tune in for a compelling conversation that sheds light on the experiences of medical professionals who stand strong on the frontlines when their community needs them the most.

On this episode, join host Eoin Walker as he sits down with Jim Bond, an experienced consultant in travel and exhibition medicine, to discuss the critical decline of the African wild dog population across Africa. Jim shares his extensive knowledge and passion for one health, particularly in the context of the rabies risk reduction scheme. Together, they explore the various threats facing the African wild dogs, from persecution and poaching to diseases and habitat loss. They delve into the importance of vaccination and the challenges of reaching remote areas with low population density. Jim also discusses his plans for conducting a real-world prospective study on rabies vaccination in African wild dogs, comparing different methods of vaccination. Throughout the episode, they highlight the need to engage local communities, address vaccine hesitancy, and implement community-led public health approaches. As they wrap up the conversation, they emphasise the urgency of prevention and the goal of eliminating rabies from Africa by 2030. Tune in to this eye-opening episode to learn more about the fascinating African wild dogs, their unique social structure, and the efforts being made to protect this critically endangered species.

Jim Bond is a passionate wildlife enthusiast who has dedicated his life to studying and protecting the African wild dog, also known as the painted wolf. With over 50 names associated with this unique species, Jim is fascinated by its distinct characteristics that set it apart from other members of the dog family. Having diverged from other wolf-like species millions of years ago, the African wild dog's four toes on its front feet allow for an extended stride, making it the most efficient carnivore predator in Africa. Jim is amazed by the success rate of the African wild dog, with a remarkable 70% to 80% success rate in hunts. He is particularly captivated by their large, round ears, which possess an incredible sense of hearing. Jim never ceases to be astounded by the beautifully patterned coat of the African wild dog, which comprises a random mix of blacks, whites, browns, yellows, and even reds. Lastly, Jim admires the species' specially adapted teeth that are second in size only to the hyena's, enabling them to quickly tear apart their prey. To Jim, studying and protecting these fascinating creatures is not only a duty but a deeply rewarding experience that highlights the intricate beauty of the natural world.

In this episode we have a fascinating conversation, we have an incredible interview with a true renaissance man, Emil Sante. With an impressive background as a paramedic, ski patroller, search and rescue member, and even a coroner, Emil has truly seen it all. From his adventures on treacherous mountainsides to the solemn duties of unravelling the mysteries of death, Emil's stories will leave you on the edge of your seat. So sit back, relax, and prepare to be captivated by the remarkable tales of Emil Sante, the composed paramedic, ski patroller, search and rescue hero, and coroner.

Emil Sante is the Lieutenant Paramedic for the Telluride Fire Protection District. He has amassedan incredibly diverse and dynamic career with 26 years in EMS, 25 years in SkiPatrol, 12 years as a extremely rural County Coroner, and 5 years as a flight medic. He has always been willing to step up and serve the needs of hiscommunity in remote San Miguel County Colorado.

Today we have a topical special on heat stroke, following the record-breaking temperatures across Europe recently peaking at 44 degrees Celsius!

Heat stroke is one of the truly terrifying environmental emergencies, with a mortality rate approaching a staggering 33% (when associated with hypotension). Not only does it have an extremely high mortality rate – but also leaves many patients with significant functional impairment with around 1 in 3 having moderate to severe functional impairment at discharge. In a wilderness environment it can be challenging to treat and is a truly time critical emergency where ‘time is organ function’.

Eoin and Ffyon discuss the Wilderness Medicine Society's guidelines and their own experiences of managing heatstroke in wilderness environments.

Welcome to part two of Kilimanjaro Diaries!

Ffyon Davies was invited to support a charity trek up Mount Kilimanjaro as the medic last year, alongside Francis Screech. Their first-time ascent of the tallest freestanding mountain in the world was both thrilling and nerve-wracking for her. Although she had prior experience climbing Mont Blanc, Kilimanjaro presented new challenges with its extreme altitude. In this episode, Ffyon and a fellow medic reflect on their adventure to the top by listening to Ffyon's voice recordings made during the climb. They discuss the realities of climbing Kilimanjaro as expedition medics, from managing altitude sickness to the underestimated demands on the body at 19,000ft. Both gained valuable insights from this unforgettable trip to Africa's highest peak.

Welcome, to Kilimanjaro Diaries... Part one!

Ffyon Davies was invited to support a charity trek up Mount Kilimanjaro as the medic last year, alongside Francis Screech. Their first-time ascent of the tallest freestanding mountain in the world was both thrilling and nerve-wracking for her. Although she had prior experience climbing Mont Blanc, Kilimanjaro presented new challenges with its extreme altitude. In this episode, Ffyon and a fellow medic reflect on their adventure to the top by listening to Ffyon's voice recordings made during the climb. They discuss the realities of climbing Kilimanjaro as expedition medics, from managing altitude sickness to the underestimated demands on the body at 19,000ft. Both gained valuable insights from this unforgettable trip to Africa's highest peak.

Stay tuned for part two of the Kilimanjaro Diaries by subscribing to the podcast today so you don't miss out on the next chapter of Ffyon and Francis' journey up Kilimanjaro!

In this session Eoin speaks with Claire Park on a new primary triage tool developed by Claire and a research team. It has been accepted and agreed by NHS England for use by all UK ambulance services and prospectively by National Police and Fire Services. It has also been adopted by the UK MOD to roll out across all UK military personnel internationally.

Claire Park is a Consultant in Pre-hospital Emergency Medicine for London HEMS, and Anaesthesia and Critical Care Medicine at Kings College Hospital in London. She also is an army consultant with over 20 years of deployed military experience. Claire is the medical adviser to the Specialist Firearms teams of the Metropolitan Police Service, and has worked closely with all of the emergency services in London on developing the joint response to high threat incidents, in particular following the attacks of 2017.

She is the Chief Investigator on a UK nationally funded research grant looking at evidence for improving patient outcomes in the hot zone in major incidents and has developed relationships in this area with many members of the Committee Tactical Emergency Casualty Care CTECC over the last 4 to 5 years.

In this session we are speaking with Justin Shook on his experiences as a Parachute Jump Medic (PJ for short) with 131st Rescue squadron Pararescue. Justin is a senior team leader, paramedic, jump master, dive supervisor and instructor, evaluator and chief of weapons and tactics at Moffett Federal Air Field in California.

Get ready for a podcast journey as Justin takes us deep into the captivating world of debriefing, preparedness, and the extraordinary life of a parachute jump medic. Learn how these principles extend beyond the boundaries of mere lifesaving, reaching into the very heart of thriving in both business and military environments.

We dive into the exclusive selection process for pararescue, where candidates are pushed to their absolute limits, both mentally and physically. Justin spills the beans on the intense training program, advanced medical certifications, and even their involvement in space shuttle astronaut recovery.

Plus, we discover the awe-inspiring challenges faced by parachute jump medics in remote areas like Colombia and Mongolia. Justin's gripping accounts of building relationships with local forces and overcoming communication barriers will leave you on the edge of your seat.

Be inspired by the art of improvisation and the unwavering mindset that sets parachute jump medics apart. Justin's tales of resilience and determination will resonate deeply with you as he unveils the never-give-up attitude that defines this extraordinary community.

So, whether you're a thrill-seeker or simply someone hungry for remarkable stories of courage and expertise, this episode promises to take you on an unforgettable rollercoaster ride through the realms of debriefing, preparation, and the incredible life of a parachute jump medic.

Following International Paramedics Days we wanted to carry on the conversation. In this episode we will examine the current climate of critical care within the UK, how that looks and the journey of where its come from. We examine the anatomy of competency, portfolios, the journey towards MSc established programmes, intervention & drugs Vs critical thinking and much more.

 Eoin Walker is joined by Tom Archer and Mike Palmer. Tom started his career in the ambulance service in London in 2004 before moving to Wales in 2010, predominantly working in central London as a Paramedic, fast response paramedic and now an Retrieval practitioner in Critical Care with ERMTS in Wales. Mike Palmer qualified in London Ambulance Service as a Paramedic and specialised in Hazardous Area Response before becoming a flight paramedic on London’s Air Ambulance. He now flies as a Critical Care and Retrieval practitioner for EMRTS in Wales.

In this session our newest podcast host Sarah Spelsberg speaks with Stephen Wood about emergency concerns and preventive warnings heading into the Fourth of July holiday in the US – a holiday renowned for increased trauma, burns, and explosive injuries - as well as how he balances his extreme/tactical medicine careers with his leadership, research and academia. Stephen proves that you really can have it all in your career.

Stephen is an acute care nurse practitioner and program director for the acute care nurse practitioner program and the new Extreme Medicine program at Northeastern University in Boston, Massachusetts. He is also the Field Operations Director for the US for World Extreme Medicine. He is currently working clinically in the ED at Carney Hospital in Boston, Massachusetts. Previous to this he was the director of advanced practice providers in the division of pulmonary and critical care medicine at St. Elizabeth’s Medical Center from 2021 - 2023 and the director of affiliated providers in the division of pulmonary and critical care medicine at Carney Hospital from 2020- 2021 during the COVID Pandemic. Prior to this he spent 11 years practicing as a nurse practitioner in emergency medicine. His roots are in EMS, and he has over 30 years of field experience, including nine years as a flight paramedic. Most recently, he was a medic for a regional SWAT team and an event EMT for the Boston Red Sox. His EMS involvement currently includes his work with the FDNY EMS fellowship and with training various fire departments in Rescue Task Force. He is a former fellow in Bioethics at the Center for Bioethics at Harvard Medical School and a current visiting researcher at the Petrie-Flom Center at the Harvard Law School Petrie-Flom Center for Health Policy.  He was the associate director for the BIDMC Disaster Medicine Fellowship for five years and worked with the Be Like Brit orphanage in Haiti both on-ground and doing telemedicine. He holds a Master of Science in Nursing as well as a Master of Science in Toxicology. He has also been a podcaster and conference host for World Extreme Medicine. He has a number of scholarly publications including book chapters, peer-reviewed articles and blogs. His hobbies include writing, reading, magic and lobstering.

On this episode, Eoin Walker and guest Gregg Brady discuss the importance of pre-hospital triage, particularly in high-stress environments like active shooter incidents. Brady, who is the Deputy Chief for FDNY, discuss pre-hospital triage, its evolution and utility in modern day medicine. Incidents involving active shooters, violent extremists, barricade situations or other acts of aggressive deadly behaviours represent some of the most challenging responses to the first responder community. These types of responses test the capabilities of first responders—including mass-casualty care. The FDNY is the primary response agency to mass casualty incidents in New York City, which continues to be a potential target for domestic and international terrorism. Captain Gregg Brady has spearheaded an innovative approach to FDNY Warm Zone Triage to quickly address severely injured patients in an environment under possible threat. The discussion also covers assessment techniques for airway, massive haemorrhage, chest wounds, tension pneumothorax, and the importance of categorising patients appropriately in order to provide the best possible care. Brady emphasizes the importance of simplicity in interventions and treatments, and stresses the need for a shift in mindset for healthcare professionals in mass casualty incidents.

Jeremy Joseph, a consultant ophthalmic surgeon began his medical school training in 1977. He then conducted his ophthalmology training at the Royal London Hospital. He was appointed as a consultant in 1994. He then continued his post at the Central Middlesex Hospital. Mr. Joseph retired from practice in 2018 with the intention of continuing to work abroad for charities.

On this episode Jeremy speaks to Pavandeep Singh to discuss the world of extreme medicine and ophthalmology. Mr. Joseph, a consultant ophthalmic surgeon with extensive experience in cataract surgery and ophthalmology across the globe, trained Singh in manual small incision cataract surgery during a trip to Bolivia. The speakers delve into the challenges of surgery in low-resource areas and adapting to different environments, including language barriers and inadequately skilled staff. They also highlight the importance of encouraging local surgeons and not imposing methods used in one's home country. Jeremy emphasise the life-changing benefits of going on expeditions as a way to give back and make a difference. The episode also features the Jeremy's personal experiences, including his first expedition abroad to Brazil and his resilient mindset.

On this episode, host Ffyon Davies speaks with Charlie Mize about his experience establishing specialty care and a prehospital critical care air retrieval program in Bhutan, as well as founding his own aviation consulting company. Charlie also discusses his expertise in emergency medicine and offers insights on providing elite care in low-resource settings. He emphasises the importance of returning to first principles to save lives and prevent morbidity, and shares examples from his own work including a group of nurses providing medical assistance in a remote area of Bhutan. The episode covers a range of medical topics from epidural decompression to wildlife safety, and offers valuable lessons for emergency medicine professionals and enthusiasts alike.

Charlie Mize is a trained emergency medicine specialist with experience in both pre-hospital and in-department emergency care. He first trained as a general physician in the US before specialising in emergency medicine and resuscitation. He spent a year teaching at Yale's emergency medicine residency program before moving overseas to work in southeast Asia. While in Bhutan, he helped establish their pre-hospital care system and founded their pre-hospital critical care air retrieval program. This led to the creation of Bear Badger, a company that provides medical consulting, design, and capacity-building services. They work on projects like high-risk cartography to facilitate rescue operations in austere locations. Charlie is currently involved in discussion for another mapping project and aims to focus on creating consistent medical care during treacherous evacuation programs.

"Nothing is impossible if you believe in yourself, despite the difficulties you may face."

Rebekka started her career as a medical technician before qualifying as a paramedic in Switzerland. After completing her Master’s degree in Mountain Emergency Medicine, she started working as a freelance flight paramedic, which led her to working as the lead critical care and flight paramedic on Denali. After working as a freelance for Air Zermatt for 3 years, she now works for them full time and is their first female paramedic.

Our host Ffyon, discusses her journey into the profession, including her time spent on high patrol for Mount Denali, the highest peak in North America. We also speak to Rebekka about Air Zermatt, a helicopter-based rescue organisation in the Swiss Alps that performs various rescues, including the use of Dynamic Winching, a technique not commonly used in the UK.

Join us as we delve into the mental and physical challenges of high altitude medicine and what it takes to perform rescues in some of the world's toughest terrains.

Cat is an NHS dentist in Cornwall and a recent faculty member of World Extreme Medicine, teaching expedition dentistry. She has always had a passion for adventure and helping others and this has led her on a journey across the globe. From the jungles of Borneo to the deserts of the Gobi, the African grasslands and the mountain regions of Nepal and Patagonia, Cat has travelled extensively to provide dental care and training to remote communities. She has now set her sights on the most remote continent on earth and a more ambitious challenge...

This will involve her skiing 700 miles in an unsupported expedition to the South Pole, in temperatures as low as -50c and wind speeds of up to 60 mph. Only a handful of female adventurers have completed this solo, unsupported trek to the South Pole. She is hoping to add her name to that number and also in the process raise funds for charities ‘Bridge to Aid’ and ‘Community Action Nepal’

You can support Cat here: https://www.gofundme.com/f/molarexplorer

In this episode we explore unconventional career paths into extreme medicine. Many people in extreme medicine have led extraordinary careers – and sometimes they have even led more than one extraordinary career. Most of us in extreme medicine start out in medicine as our primary career …..and then work to combine our passion for medicine with our passion for the extreme!  Jamie flipped that idea on its head, starting out as a mountaineering instructor and later qualifying as a doctor following his experiences in the Ogwen Valley Mountain Rescue Team.

Jamie is a mountaineering instructor, mountain rescue medical lead and doctor in North Wales. Jamie started out his career as a marine biologist, before qualifying as a mountaineering instructor, and going on to join Ogwen Valley Mountain Rescue and discovering a passion for pre-hospital and emergency medicine. Following this he retrained as a doctor and continues to pursue an unconventional career path in North Wales as an anaesthetist with a passion for teaching and the outdoors!

Eric Pirie has taken an interesting career path; starting in a non medical job, journeying through Mountain Rescue, a full time outdoors instructor and culminating in qualifying as a paramedic in his fifties.

Eric joins Deb Swann to discuss how you can forge your own career pathway to combine an outdoors passion with a medical career. Eric discusses his experience of working with Mountain Rescue, the skills and experiences needed to support the teams, and how it ultimately encouraged him to qualify in paramedicine where he now works for the Scottish Ambulance Service.

James Thacker is a IFMGA Mountain Guide, member of the British Association of Mountain Guides (BMG) and Mountaineering Instructor (WMCI) splitting time between Chamonix, France, and Kingussie, Scotland. James' enthusiasm for working in the mountains has taken him to Arctic Greenland, the Himalayas, the "classic north faces" of the European Alps and rock climbing around the world.

For sixteen years James was actively involved with Mountain Rescue in the Peak District as a member of Derby MRT and Edale MRT. With this casualty care experience James has also developed an interest in the management of patients in the mountains, and is enrolled on the ORMS Hazardous Environment Medical Technician (HEMT) scheme. In recent years James has also contributed to the wider agenda of mountain safety via the British Mountaineering Council (BMC), and is a Trustee of the Chris Walker Memorial Trust (CWMT). CWMT strives to fund and deliver, in conjunction with the Scottish Avalanche Information Service (SAIS), continuing professional development training in avalanche awareness in Scotland. James is also an Observer/Forecaster for the Scottish Avalanche Information Service (SAIS) and member of the Applied Psychology and Human Factors (APHF) group, collaborating with Aberdeen University and various sectors of industry.

In this session James speaks to us about fundamentals of Mountain Rescue in the Alps, including:

Origins of:

• James MR experience
• Derby MRT and Edale MRT
• The HEMT scheme and what it gave James
• Involvement with the BMC

Alps:

• The differences in landscape and challenges between the alps and Cairngorms
• Technicality of rescue in the Alps
• Changing conditions/factors to consider
• Avalanche risk
• Cold injury
• Altitude
• Seminal cases

In this episode, Will Duffin is joined by Ffyon Davies, a fellow extreme medic, to discuss her most memorable moments in the field. They delve into her experiences in Mountain Rescue and as an Expedition Medic on Mount Kilimanjaro, which is considered one of the most challenging roles in the field. The conversation covers a range of topics including team dynamics, leadership, casualty management, wilderness fracture management, and more. They also explore how to tackle the unique challenges of expedition medical care such as preventing water from freezing at high altitudes and managing a spread-out group. Other important aspects discussed include understanding one's limits, vulnerability modeling, the significance of having a trusted colleague to confide in, and coping when one is struggling at altitude while others in the group need treatment. The episode is packed with valuable insights and practical advice for anyone interested in extreme medicine.

About Ffyon:

Ffyon is an ED Registrar based in North Wales. Usually found either outdoors, at work or both, she is currently a clinical fellow in ED, ICU and PHEM (working with EMRTS Air Ambulance) at Ysbyty Glan Clwyd. She is an 'FY5', taking a slightly circuitous route to qualifying in Emergency Medicine via the CESR pathway, taking time out wherever possible to do what she loves undertaking expedition medicine roles which have included working as chief medical officer on worked as chief medical officer on board Tall Ship Pelican of London, sailing from Germany to Tenerife, and as a trail medic supporting ultramarathons in Wales and the Azores islands.

When she's not working, she's out playing in the mountains hiking, running, climbing and kayaking, usually accompanied by her trusty welsh collie Foxy. She also volunteers with her local mountain rescue team, North East Wales Search and Rescue. She has completed her Mountain leader training and is also a qualified Elementary Paragliding Pilot.

In this chat Becky Hartshorn discusses her successful completion of the Pacific Crest Trail. Known as the PCT, it is America’s second longest trail, stretching from Mexico to Canada through the states of California, Oregon, and Washington. The route takes in many of America’s most scenic and varied terrain—from desserts to mountains to alpine plateaus. The PCT is 2,650 miles long (4,265 kilometres). Starting in Campo, a small town on the United States-Mexico border, it goes through California, Oregon, and Washington before reaching its northern terminus at the United States-Canada border in Manning Park, British Columbia. The trail is divided into 30 sections: 18 sections in California, 7 in Oregon, and 5 in Washington. The average length of each section is 91 miles.

Becky Hartshorn is a Junior Clinical Fellow/F5 doctor currently working in Emergency Medicine in Sheffield. Becky is interested in Wilderness and Expedition Medicine, and has completed one of the World Extreme Medicine courses in Slovenia and is working on her Mountain Leader qualification. She’s a keen hiker and wants to be able to keep racking up the miles as well as having a career in Emergency Medicine.

On the anniversary of the war in Ukraine beginning, in this session we speak with Mark Hannaford, Luca Alfatti, and Aliona Hlivco around the current logistical aid efforts, implementation, climate and anecdotal reflections in Ukraine.

We also dig into the of change in the current climate from an infrastructural perspective, logistical effort and the real need on the ground from the guest’s experience.

https://worldextrememedicine.com/blog/humanitarian-medicine-posts/medics4ukraine-fundraising-appeal/ 

In this episode Deb Swann talks to Eoin Walker about her recent deployment to Hatay, Turkey, near the border with Syria in response to the recent devastating earthquake with the UKISAR team. Deb is an Advanced Clinical Practitioner and a member of the World Extreme Medicine faculty.

Deb has been a part of the UKISAR team for ten years and is the only nurse on their rescue team. In this podcast she reflects on her experience of her most physically and emotionally challenging deployment to date, and her thoughts around the team she worked within, the patients she treated and the communities they helped.

In this session we speak with with Rebecca Marcussen-Lewis on maternity training in Low- and Middle-income countries and developing contexts. Rebecca is a trained Midwife and graduate of the MSc in extreme medicine and has recently been working on the ships with SOS Méditerranée. SOS MEDITERRANEE is a humanitarian organisation that advocates on behalf of all people in distress at sea, without partiality as concerns their nationality, country of origin, social belonging, religious belief, political or ethnic affiliation. Since it first started operating at sea in 2014, SOS MEDITERRANEE has been patrolling the central Mediterranean in international waters between Italy and Libya where most boats in distress occur. The rescues take place outside Libyan territorial waters (known as the 12-mile zone). Rebecca talks through what she has learnt when she has been involved with both training and practising midwifery on these ships.

Rebecca is a clinical midwife and is currently working in Search and Rescue in the Central Mediterranean as team leader of a diverse multi-organisational medical team.

Rebecca trained as a midwife specifically to work in the humanitarian field having grown up in a medical family hearing of memories from Biafra and Zambia. Following completion of her initial clinical training, she began working in the field with Yazidi Emergency Support whilst undertaking the WEM Post Graduate Diploma with the University of Exeter.

She is continuing to try and encourage other midwives and birth professionals into the humanitarian setting and to build knowledge about women’s health to dispel the common fear and apprehension in other clinicians around these topics.  Outside of her humanitarian work, she spends as much time as possible with her two very fluffy and energetic dogs.

Jonah is a 5th Year Medical student at the University of Dundee. Jonah has been whitewater kayaking since he was 12. This passion recently took Jonah as part of the British University Kayak Expedition team to Central Kalimantan, Borneo. This 6 week expedition focused on descending unexplored sections of whitewater deep within the rainforest. The team had to be totally self-sufficient and with no support team everything had to fit in the back of a kayak. Jonah discusses the challenges of delivering medical care not only as a medical student, but with a first aid kit small enough to fit in the back of a boat. All the while navigating grade V rapids, flashfloods and dealing with unfriendly locals. He chatted to Deb Swann about planning and executing an expedition as a medical student.

Susan Schiller holds the rank of Deputy Superintendent for Boston Emergency Medical Services (BEMS) and has over 30 years’ experience as a critical care medic and clinical researcher. In 2011 she was promoted to Shift Commander overseeing tactical operations in the field.  She is the recipient of numerous awards including, the Pozen Paramedic of the Year award for exemplary medical care; the Lashman Humanitarian Award for exemplifying compassionate care; is a 3-time recipient of the Unit Citation for extraordinary action in the line of duty; and is a 7-time recipient of the Pre-Hospital Save Medal for extraordinary resuscitation in the austere environment.

Susan is a former adjunct faculty member of clinical training for the Massachusetts College of Pharmacy and Health Sciences and is currently adjunct faculty for the Boston Medical Center’s ACGME EMS Fellowship. She has lectured nationally and internationally on multiple pre-hospital subjects including the response to the Boston Marathon Bombings. She holds a dual bachelor’s degree in biology and Philosophy from Clark University, and a master’s degree in Homeland Security from Northeastern University.

Susan talks to host Stephen P Wood about planning for large scale events, and how communication, and training is key in how to respond when in progress.

In this episode Dr Will Duffin takes a deep dive into Dr Iserson's book: 'Improvised Medicine'.

Dr Iserson is Professor Emeritus of Emergency medicine at The University of Arizona and former Medical Director of the Southern Arizona Rescue Association. He has published hundreds of scientific articles on emergency medicine and biomedical ethics and authored numerous books.

Dr Iserson describes Improvised medicine as 'a spectrum of ad hoc equipment and special methods and knowledge for advanced health care practitioners' with an emphasis on 'opening your mind to ways of solving problems in a crisis and providing options for you (and your patients) when alternatives seem limited or nonexistent.'

'The difficult we do immediately. The impossible takes a little longer'

-US Air Force.

In this episode the pair discuss:

• The origins of improvised medicine and how it draws on the history of medical practice through the ages. Some techniques are surprisingly effective even today.
• Hypnosis as effective analgesia
• Diagnostics - including direct auscultation, stethoscopes as hearing aids and making 3D X Rays using the power of your eyes.
• Digital intubation techniques
• How Dr Iserson sited three endotracheal tubes as chest tubes in a major trauma scenario.
• Intraosseous infusions using regular needles
• Safe patient evacuation of a vertical hospital
• Substitute medications
• Medicine expiration dates - do they matter?
• Techniques that definitely don't work including the mythological emergency front of neck access using a biro.
• The ethics and medicolegal implications of using improvised techniques - how this tallies in with the doctrine of 'first do no harm' and when it is appropriate to deviate from established protocols, techniques and guidelines.

In this session we are speaking with Ryan Atkinson about his vast experience working across the globe as a cinematographer. Ryan has spent 12 years filming wildlife and science filmmaking for the likes of the BBC Natural History Unit, Netflix and National Geographic. His work has taken him to over 50 countries on 6 continents, specialising particularly in polar and mountain environments and has seen him join expeditions of all shapes and sizes; from a 20 strong team abseiling into the world’s most active volcano, to months spent following polar bears across the Norwegian pack ice, and long solitary hours on skis looking for foxes amongst the Canadian wilderness. No stranger to expedition hazards, he gets very cold hands after experiencing ‘minor’ frost nip in -37 degrees, has been medevac’d following a scorpion sting in Tanzania, and has ongoing adventures involving jungle fungus. Having also volunteered for 8 years as a member of mountain rescue, his life took a slight turn with the onset of the Covid-19 pandemic.

Swapping tropical jungles for concrete jungles in 2021, he’s now about to finish training as an emergency medical technician with London Ambulance Service, with a particular interest in trauma and critical care and a view to progressing onto his paramedic training in 2023. Ryan hopes to have a long and fulfilling second career ahead of him, combining clinical learning and work within NHS Ambulance trusts, with expedition medicine, photography and far fewer scorpions.

You can find out more about Ryan here - http://ryanatkinson.tv/ 

David Rovardi is a dual qualified pharmacist and paramedic and is currently working as a Specialist Practitioner with EMAS. He also works one day a week for the College of Paramedics advising the College on the latest legislation within Prescribing and Medicines Management.

In this session Eoin speaks with David Rovardi around the current situation on prescribing rights for paramedics. There have been twists and turns of over 10 years and some of the key moments such as public consultation of CDs in 2014 and the turning point in legislation by the commission for human medicines in 2018.  They examine exactly where the profession is in relation to permission to prescribe, and also dig into the caveat of advanced practice, double unlock and what it means, what are who the ACMD are, the list of controlled drugs on the register, the joint letter with the Royal College of GPs, the strategy for the full list of CDs to be administered by paramedics, the difference between off licensed drugs and unlicensed drugs and more.

In this session we will be interviewing Dr Lachlan McIver on his recent book, Life and Death Decisions, a memoir that combines Lachlan’s personal journey with loss of his father, working with international aid agencies, navigating war torn countries and low resource settings. In the episode we will be examining some of the over-riding themes, Lachlan’s reflections and some of his salient revelations from working in over 30 countries and regions.

Lachlan specialises in rural & remote medicine, tropical medicine, and public health, and has a PhD in global health. He currently works as the Tropical Diseases & Planetary Health Advisor at the headquarters of Médecins Sans Frontières in Geneva. Lachlan’s work has taken him to thirty different countries, and he has published over forty scientific articles and textbook chapters.

You can find out more about Lachlan here 

https://drlachlanmciver.com/ 

https://twitter.com/lachlan_mciver

Growing up Priteni was never sporty or particularly active, she liked being indoors as much as she liked being outdoors. It was not until sixth form that she did anything really adventurous and even now she thinks she only decided to do the Gold DOE Award because her friends were. 

That experience, till this day, is one of her most precious memories and turning points in her life, when she looks back at it now she realises it was a catalyst, it showed her she had some wild in her and that it needed to be nurtured. 

A year later she planned a trip with her friend to South East Asia and Japan. However it was not that big adventure that showed brought out her wild pursuit, it was DOE, walking across Dartmoor with map in hand and her existence on my back that gave her the courage and the confidence to feel she could achieve things and she has not looked back since. She now thrives on planning adventures whether it be sleeping out under the stars or dreaming of cycling to Australia to see friends. 

Priteni talks to World Extreme Medicine host Jennie Sherman about supporting Bex Band and her adventure across the UK which was completed in August. You can find out more about it here https://www.loveherwild.com/about/ 

Dr Dan Pronk served on over 100 combat missions in Afghanistan as a frontline special forces combat doctor, where the casualties he treated were his fellow SAS soldiers and commandos, local civilians and even the enemy.

The thrill of adventure and the challenges of battlefield medicine brought out the very best in Dan; he discovered a sense of purpose in pushing his medical skills and courage to the limits. But there was a cost.

Dan Pronk has written his memoirs 'The Combat Doctor' and chatted to Eoin about the messages in the book and the powerful learning in the line of duty. Dan currently works as a Senior Medical Officer in the Emergency Department in a regional hospital and serves as the medical director for Techmed Australia.

https://www.panmacmillan.com.au/author/dr-dan-pronk/ 

https://www.instagram.com/danpronk/?hl=en 

In this session we will be speaking with Dan Stretch on the challenges of casevac from Nepal and Pakistan. Dan works as the Operations Manager at Global Rescue LLC within the APAC region and has had to retrieve and coordinate retrieval of critically ill patients from some of the most challenging regions in the world. The region Dan operates in include the Himalayas in Nepal, and K2 in Pakistan. These mountain ranges are collectively some of the deadliest in the world and pose some of the most difficult retrievals that any air ambulance system could face. There has also been a 4-fold increase in retrievals post covid, something we will dig into further in the interview.

In this conversation we will look at Dan’s approach to crisis response operations. Also, the coordination and logistics for transfer from these remote locations (includes air, ground, sea, etc.) and the training involved in maintaining operational response readiness. We will also look at the difficulties of getting accurate information from the scene of the incident, and logistics efforts required to get these patients out of the environment. We will speak about transfer in and out of Tenzing–Hillary Airport, also known as Lukla Airport – one of the most difficult airports to fly in and out of.

In this episode, Stephen Wood is joined by Allen Lewis, who is an Adjunct Professor with Columbia Southern University and an Associate Consultant for Emergency Service Consulting International in addition to performing emergency and security sensitive work outside the United States. 

They discuss Allen's experiences in disaster response and humanitarian response while working in developing countries focussing on cultural competence.

As a paramedic, he has worked in medical services aboard ships above the Arctic Circle, in de-mobilized child soldier camps in South Sudan, mobile high threat protection teams in Afghanistan, and aboard helicopters over Iraq. As a well-travelled instructor and consultant in the fire service and EMS profession, he has trained firefighters in the Democratic Republic of the Congo, Guatemala, and Iraq. Mr. Lewis has lived, worked, or travelled to 98 countries in his 25 years of fire, rescue, and EMS experience. A significant amount his career has been spent in non-permissive environments such as Iraq and Afghanistan he worked as a personal security specialist/paramedic under the U.S. State Department’s Diplomatic Security High Threat Protection Program protecting American ambassadors.

He is a National Fire Academy Executive Fire Officer (EFO) graduate, a Center for Public Safety Excellence (CPSE) credentialed Certified Fire Officer (CFO) and Certified Emergency Medical Services Officer (CEMSO), a Certified Emergency Manager (CEM), as well as a Nationally Registered Paramedic, certified International Fire Service Accreditation Congress (IFSAC) Fire Officer, Instructor, and Investigator with the Minnesota Fire Service Certification Board. Professor Lewis holds dual Associate of Applied Science degrees in Fire Suppression Technology and Emergency Medical Technology - Paramedic from Chemeketa Community College, a Bachelor of Fire Service Administration from Western Oregon University, a Master of Public Administration from Columbia Southern University, and an Executive Certificate in Public Leadership from the Harvard Kennedy School of Executive Education.