This week, Aebhric O’Kelly is joined by Bill Vasios and Rhod Jordan for an interactive discussion on one of the most important and often overlooked areas of remote medicine: Austere Primary Care.
Whilst trauma often dominates training, the reality is that most remote clinicians spend far more time managing diarrhoeal illness, skin infections, musculoskeletal injuries, respiratory complaints, fever, environmental illnesses, and preventative healthcare. The panel discusses the clinical mindset required to work in resource-limited environments, introduces CoROM's CHART patient assessment system, and explores practical approaches to diagnosis when advanced investigations are unavailable.
Whether you work in expedition medicine, offshore healthcare, humanitarian operations, military medicine, or remote primary care, this episode provides practical insights into becoming a more capable austere clinician.
Chapters
00:05 – Welcome to CoROM Conversations
00:17 – Why primary care matters more than trauma in remote medicine
01:10 – Defining austere and resource-limited environments
02:00 – Developing the austere clinical mindset
02:40 – Becoming comfortable with uncertainty and limited resources
04:00 – Building confidence through deliberate practice
05:00 – Wilderness medicine and learning outside the ambulance
07:15 – Resilience and supporting expedition teams
08:00 – Common primary care presentations in austere environments
08:15 – Gastrointestinal illness, dehydration and traveller's diarrhoea
08:45 – Skin disease, wound care and blister management
09:30 – Environmental illness: hypothermia, frostbite and heat injury
10:10 – Musculoskeletal injuries in expedition medicine
11:55 – Learning orthopaedic assessment through repetition
13:00 – ENT, eye and dental emergencies
14:20 – Introducing the CoROM CHART assessment framework
16:40 – Chief Complaint, Condition and the CPRO assessment
17:20 – Recognising the critically ill patient
20:15 – History taking using SAMPLER with additional risk assessment
22:00 – Secondary assessment using the BEAST observations
26:10 – Review of systems using CRANES
27:30 – Treatment, disposition and clinical trending
28:10 – Diagnostic tools for austere medicine
30:30 – Essential point-of-care investigations
31:00 – Why every diagnostic tool needs a backup plan
33:00 – Altitude, pulse oximetry and interpreting observations
34:00 – Fever assessment in austere environments
34:45 – Measuring temperature correctly in older adults and children
35:40 – Managing fever of unknown origin and malaria
36:10 – Nursing care and prolonged patient management
36:45 – Public health and preventative medicine
37:30 – Recognising clinical red flags
38:00 – Key learning points and deployment preparation
39:00 – The importance of clinical examination over technology
40:00 – Trusting your senses and treating the patient—not the monitor
41:00 – Closing remarks and CoROM CPD opportunities
Key Topics Discussed
Austere primary care
Clinical reasoning in resource-limited environments
The austere clinical mindset
Preventative medicine
Travel medicine
Wilderness medicine
Expedition healthcare
Remote diagnostics
Fever of unknown origin
Malaria diagnosis
Environmental medicine
Musculoskeletal injuries
Skin disease
Point-of-care ultrasound
Nursing care in prolonged field care
The CoROM CHART assessment system
CPRO and BEAST observations
Differential diagnosis
Key Takeaways
Most remote clinicians spend considerably more time managing primary care conditions than major trauma.
Clinical confidence develops through experience, deliberate practice and mentorship.
Every piece of diagnostic equipment should have a backup plan.
Careful history taking remains one of the most valuable diagnostic tools available.
Trend observations over time rather than relying on single measurements.
In malaria-endemic regions, malaria should remain high on the differential diagnosis for every patient with fever.
