1 00:00:04,880 --> 00:00:07,600 Hello everyone and welcome to the Quorum podcast. 2 00:00:07,640 --> 00:00:11,320 This is where academic medicine meets remote, austere and 3 00:00:11,320 --> 00:00:17,960 resource limited areas. Welcome back to the podcast, 4 00:00:17,960 --> 00:00:22,240 this is Avacol Kelly. This week we are again joined by 5 00:00:22,240 --> 00:00:26,040 Eric Holmstrom, who is the Director of our CPD programmes 6 00:00:26,040 --> 00:00:30,280 at the College and has been on our faculty for almost a decade 7 00:00:30,280 --> 00:00:32,400 now. Eric, welcome back to the. 8 00:00:32,400 --> 00:00:34,320 Programme. Thank you, Eric. 9 00:00:34,440 --> 00:00:38,000 It's good to be back again. So, Eric, tell the listeners 10 00:00:38,000 --> 00:00:43,320 what exactly you do for Quorum. So basically I'm supervising and 11 00:00:43,960 --> 00:00:48,320 organising the CPD courses, the online courses at our website. 12 00:00:48,320 --> 00:00:52,880 So I follow up students who have any questions or any technical 13 00:00:52,880 --> 00:00:57,280 issues and try to sort that out. And I also manage all the 14 00:00:57,280 --> 00:01:00,760 practical courses at our location in Malta. 15 00:01:00,840 --> 00:01:05,040 Register the students when I get them from the registrar and make 16 00:01:05,040 --> 00:01:07,720 sure that they get the information that they need to 17 00:01:07,800 --> 00:01:12,640 join us down in Malta. And making all the planning and 18 00:01:12,640 --> 00:01:15,160 preparation for the courses for the bachelor students, the 19 00:01:15,160 --> 00:01:18,360 master students and also for the CPD students who want to do a 20 00:01:18,360 --> 00:01:22,920 practical training in Malta. So part of that is you run the 21 00:01:22,960 --> 00:01:27,440 online CPD programmes, which is the the MC, MC and farm was was 22 00:01:27,440 --> 00:01:29,320 the first three. They were the first three that 23 00:01:29,320 --> 00:01:31,800 we started. We've we've had more online 24 00:01:31,800 --> 00:01:35,240 programmes join the 1st 3. But today we're going to talk 25 00:01:35,240 --> 00:01:39,040 about the MC, the minor illness course, MC, the minor 26 00:01:39,040 --> 00:01:42,720 emergencies course and the farm, which is pharmacology for the 27 00:01:42,720 --> 00:01:46,480 remote medics. And Eric, you and I have just 28 00:01:46,520 --> 00:01:49,360 upgraded them. We've, we did a complete 29 00:01:49,360 --> 00:01:53,880 rewrite, redesign audit of what we had before and we've updated 30 00:01:53,880 --> 00:01:57,320 it and now it's launching. Yeah. 31 00:01:57,320 --> 00:02:00,880 As you said, Rick, the first, these first courses, I think 32 00:02:00,880 --> 00:02:04,440 they were started about 10-12 years ago where we put them on 33 00:02:04,440 --> 00:02:08,160 and they were actually quite well appreciated by the students 34 00:02:08,160 --> 00:02:11,520 and they've been upgraded sometimes according to new 35 00:02:11,520 --> 00:02:14,160 protocol, new routines and new treatments. 36 00:02:14,160 --> 00:02:18,400 But now we actually have taken those three courses and totally 37 00:02:18,400 --> 00:02:21,960 renewed them. And we're also putting on a new 38 00:02:21,960 --> 00:02:24,160 platform that has more potential. 39 00:02:24,160 --> 00:02:27,720 And I think that the the launch that I think we're going to have 40 00:02:27,720 --> 00:02:31,120 on Monday next week is going to be awesome. 41 00:02:31,200 --> 00:02:34,240 And the the students who want to look into them will see that 42 00:02:34,320 --> 00:02:37,640 this is a total renewal of those 3 programmes. 43 00:02:37,760 --> 00:02:40,840 Yeah, so they go together. We, we created these as a 44 00:02:40,840 --> 00:02:45,960 package deal focusing on disease and non battle injuries, what we 45 00:02:45,960 --> 00:02:49,480 called it in the military. But I think minor illness, minor 46 00:02:49,480 --> 00:02:53,040 emergencies, primary care, general practise, that kind of 47 00:02:53,040 --> 00:02:57,040 stuff. And there's tonnes of other CPD 48 00:02:57,040 --> 00:03:00,560 online programmes out there that focus on minor emergencies, 49 00:03:00,840 --> 00:03:02,840 minor illnesses and pharmacology. 50 00:03:02,880 --> 00:03:06,640 But we did something well, we always do something different. 51 00:03:06,800 --> 00:03:12,480 We focused on the remote medic. So drawing on a lot of your 52 00:03:12,480 --> 00:03:15,920 background, Eric and special OPS as well as teaching in the 53 00:03:15,920 --> 00:03:19,120 NSOCUM course. So you you were running the 54 00:03:19,120 --> 00:03:21,560 curriculum for the Nsocum course for a while. 55 00:03:21,560 --> 00:03:25,200 What Dnbi topics were you teaching in Fullendorf, Germany? 56 00:03:26,480 --> 00:03:30,040 Well, basically the, the second course was built on, it's 57 00:03:30,040 --> 00:03:33,640 basically mostly trauma medicine and prolonged field care. 58 00:03:33,680 --> 00:03:37,000 But we also implemented these three topics that the minor 59 00:03:37,000 --> 00:03:39,920 illness and the minor emergency and the pharmacology. 60 00:03:40,240 --> 00:03:43,200 Because when we're talking a lot about trauma today and that 61 00:03:43,200 --> 00:03:46,320 that's understandable because the world is a more dangerous 62 00:03:46,320 --> 00:03:49,640 place and we have more the wars going on than we had before. 63 00:03:49,640 --> 00:03:55,840 So we mustn't lose focus on the normal things that EMTs in the 64 00:03:55,880 --> 00:03:59,280 austere environment can actually actually incur. 65 00:03:59,280 --> 00:04:02,400 And that was also one of the points in the sub course because 66 00:04:02,440 --> 00:04:05,480 the soldier has to take care of themselves when they are in a 67 00:04:05,480 --> 00:04:09,560 FOB or on patrol. And it could happen that they 68 00:04:09,560 --> 00:04:12,840 have illnesses or they have minor emergency like ankle 69 00:04:12,840 --> 00:04:15,560 sprains or toothaches or whatever you have. 70 00:04:15,920 --> 00:04:18,600 And one of the other things that's important that we focus a 71 00:04:18,600 --> 00:04:22,320 lot on the ENSOCOM is the pharmacology module because what 72 00:04:22,320 --> 00:04:26,320 we know is that pharmacology is something that people struggle 73 00:04:26,320 --> 00:04:29,200 with. We've we've seen that on several 74 00:04:29,200 --> 00:04:31,480 of our practical courses, especially when it comes to 75 00:04:31,480 --> 00:04:34,400 calculation. And I think that knowing more 76 00:04:34,400 --> 00:04:38,120 about pharmacology, knowing more about minor emergency that is 77 00:04:38,120 --> 00:04:42,960 not directly trauma and also about illnesses like diseases 78 00:04:42,960 --> 00:04:46,640 like fever, like headache and all these things that doesn't 79 00:04:46,640 --> 00:04:49,680 necessarily need commitment into the hospitals. 80 00:04:49,920 --> 00:04:54,160 I think that's a thing that all austere and remote paramedics 81 00:04:54,160 --> 00:04:57,320 should know about. That was the original reason 82 00:04:57,320 --> 00:05:02,320 that Quorum was invited into the NATO special operations combat 83 00:05:02,320 --> 00:05:06,360 medic course because we brought in this disease and non battle 84 00:05:06,360 --> 00:05:09,480 injury type thing. So we we ran with designed and 85 00:05:09,480 --> 00:05:14,040 ran the Trot Med week which included all sorts of illnesses 86 00:05:14,040 --> 00:05:18,160 and minor emergencies as well as as this pharmacology to cover 87 00:05:18,160 --> 00:05:20,680 that there was very little trauma in that week. 88 00:05:20,680 --> 00:05:23,480 And I think, and Sockham is still running the curriculum, 89 00:05:23,480 --> 00:05:26,320 what we created to bring in a bit of the Dnbi. 90 00:05:26,320 --> 00:05:30,640 So for those of you who don't know what Dnbi is, is disease 91 00:05:30,640 --> 00:05:34,160 and non battle injury. It's it's it's an army term that 92 00:05:34,680 --> 00:05:39,000 someone came up with ages ago because throughout history, more 93 00:05:39,000 --> 00:05:43,080 people in the military and military conflict died from 94 00:05:43,080 --> 00:05:46,760 diseases and non battle injuries than ever died from combat. 95 00:05:46,760 --> 00:05:50,520 It wasn't until we got the hand washing sorted with, with 96 00:05:50,520 --> 00:05:58,480 Semmelweis in 18641865 that we, we found that for the first time 97 00:05:58,480 --> 00:06:04,080 in history, fewer combatants were dying from non trauma as 98 00:06:04,080 --> 00:06:07,280 World War One was the big testing ground for this new 99 00:06:07,280 --> 00:06:14,160 concept of preventative care. And then now 150 years later, we 100 00:06:14,160 --> 00:06:18,720 are doing very well with DMBI. But we still, because who we 101 00:06:18,720 --> 00:06:23,200 are, we're SF mentality, you and I and and we just love trauma, 102 00:06:23,200 --> 00:06:26,080 trauma, trauma. And we still have to realise the 103 00:06:26,080 --> 00:06:30,120 majority of the things that we see on an operational setting 104 00:06:30,120 --> 00:06:34,080 are is not trauma. Yeah, because that's what when 105 00:06:34,080 --> 00:06:37,320 you guys come down to Fullndorf to to help us out with that and 106 00:06:37,320 --> 00:06:39,600 how the the topics of tropical diseases. 107 00:06:39,600 --> 00:06:42,440 I was thinking about OK, tropical diseases, that's just a 108 00:06:42,440 --> 00:06:45,440 small portion, especially for me coming from Norway, we don't 109 00:06:45,440 --> 00:06:48,160 have a lot of tropical diseases. We are focused more on 110 00:06:48,160 --> 00:06:50,160 hypothermia and and those kinds of things. 111 00:06:50,200 --> 00:06:53,200 But what I learned from you guys, and that's also the reason 112 00:06:53,200 --> 00:06:56,760 why I went to London School of Tropical and Hygiene to do the 113 00:06:57,080 --> 00:07:01,280 course there, because it's not only so tropical diseases is 114 00:07:01,280 --> 00:07:05,000 actually minor illnesses course also because a lot of the 115 00:07:05,000 --> 00:07:09,240 tropical diseases will put people out of operation if they 116 00:07:09,240 --> 00:07:12,400 cannot mitigate or they cannot prepare for that. 117 00:07:12,800 --> 00:07:16,960 So when you taught that tropical tropical portion of the second 118 00:07:16,960 --> 00:07:21,040 course, I learned a lot about minor emergencies and also minor 119 00:07:21,040 --> 00:07:24,160 illnesses and also a lot of pharmacology because that goes 120 00:07:24,160 --> 00:07:28,640 also into pharmacology. What kind of drugs do I need if 121 00:07:28,640 --> 00:07:32,120 I go to a tropical area? I need to know more about those 122 00:07:32,120 --> 00:07:37,200 and that's why I thought that this MIM, MEC and Pharma modules 123 00:07:37,200 --> 00:07:42,480 that we have created is actually a great add on to to people 124 00:07:42,480 --> 00:07:44,360 who's working in austerity environments. 125 00:07:44,400 --> 00:07:46,600 I'm glad you mentioned the DTN programme. 126 00:07:46,600 --> 00:07:49,640 The Diploma of Tropical Nursing from London School of Hygiene 127 00:07:49,760 --> 00:07:53,240 and Tropical Medicine and Liverpool has one as well so 128 00:07:53,400 --> 00:07:56,280 every medic should have this. If you're a military medic, 129 00:07:56,280 --> 00:07:59,800 operational medic, paramedic, or nurse, don't get your DTN 130 00:07:59,800 --> 00:08:04,040 because it covers these in such an extreme detail that it made 131 00:08:04,040 --> 00:08:05,840 me a better medic. Absolutely. 132 00:08:06,000 --> 00:08:08,960 I'm second that one because I learned a lot when I went to the 133 00:08:08,960 --> 00:08:13,040 DTN and also it made me think much about more preventive 134 00:08:13,040 --> 00:08:17,080 medicine and how we can avoid. And this is what this course is 135 00:08:17,080 --> 00:08:20,680 also covers is how can we prepare for tropical 136 00:08:20,680 --> 00:08:23,160 deployments? How can we make sure that we 137 00:08:23,160 --> 00:08:26,400 have the right vaccination? How can we prepare the camps? 138 00:08:26,400 --> 00:08:30,800 The easiest thing to to think about is what about our 139 00:08:30,800 --> 00:08:33,919 senatorial problems in austerity environment? 140 00:08:34,159 --> 00:08:38,320 We had an incident in deployment to Afghanistan within Norwegian. 141 00:08:38,320 --> 00:08:42,720 We put up a new camp in Masare Sharif and we didn't prep good 142 00:08:42,720 --> 00:08:46,520 enough, so we got a lot of diseases because the ground was 143 00:08:46,520 --> 00:08:49,520 full of rats and snakes and whatever you have. 144 00:08:49,880 --> 00:08:54,400 So we had to actually excavate all the grounds, do it again. 145 00:08:54,640 --> 00:08:58,640 So in this camp we had a big outbreak of leishmaniasis 146 00:08:58,640 --> 00:09:01,400 because or not the big, but we got some, some soldiers who was 147 00:09:01,640 --> 00:09:05,760 bitten by this little sand fly. So we learned how to prevent 148 00:09:05,760 --> 00:09:08,960 ourselves for this. And also we had a big outbreak. 149 00:09:09,000 --> 00:09:11,560 And now because of hand sanitation in the, in the 150 00:09:11,560 --> 00:09:16,800 kitchen, we had the 100 people in, in the hospitalised because 151 00:09:16,840 --> 00:09:23,120 of the dehydration. So we also had a lot of people. 152 00:09:23,200 --> 00:09:27,200 Actually we had at 100 people, I think it was in, in beds having 153 00:09:27,200 --> 00:09:31,520 the shooter and diarrhoea because we found out that on the 154 00:09:31,520 --> 00:09:34,360 kitchen, the kitchen stuff didn't wash their hands good 155 00:09:34,360 --> 00:09:36,920 enough. So it infected the entire camp. 156 00:09:37,360 --> 00:09:42,440 And we had 100 people in bed in, in a tent that we had to put IV 157 00:09:42,440 --> 00:09:45,280 fluids on everybody. And they were they, they were 158 00:09:45,280 --> 00:09:48,200 not feeling happy. So this is things that these 159 00:09:48,200 --> 00:09:52,440 courses also cover. Yeah, we we hit diarrhoea quite 160 00:09:52,440 --> 00:09:54,520 heavily. It's one of the five mad at 161 00:09:54,520 --> 00:09:58,880 diseases, the top five tropical diseases that will affect a 162 00:09:58,880 --> 00:10:00,560 casualty. We spend a lot of time on the 163 00:10:01,280 --> 00:10:04,400 our field guide about that and hydration ladder. 164 00:10:04,400 --> 00:10:07,440 I just published something on LinkedIn about the hydration 165 00:10:07,440 --> 00:10:10,720 ladder to keep someone from from dying of this disease that you 166 00:10:10,720 --> 00:10:13,560 had. Yeah, and and also talking about 167 00:10:13,560 --> 00:10:17,880 the minor emergency course in my years, I have a 30-40 years in 168 00:10:17,880 --> 00:10:22,760 the pre hospital space. Now what I see in the civilian 169 00:10:22,760 --> 00:10:25,680 ambulances in the austerity environment is we don't have a 170 00:10:25,680 --> 00:10:29,200 lot of trauma or we have minor trauma that can be fixed without 171 00:10:29,680 --> 00:10:32,040 without sending the patient to the to the hospital. 172 00:10:32,040 --> 00:10:36,600 And I think that the neck is acts absolutely perfect for 173 00:10:36,760 --> 00:10:40,720 people who want to learn more about ankle sprain, how to to 174 00:10:40,720 --> 00:10:44,440 fix toothaches, house to fix headaches and things. 175 00:10:44,440 --> 00:10:48,200 That is not necessarily that you have to send the people to a 176 00:10:48,200 --> 00:10:51,000 hospital, but they can still do the mission or if in a civilian 177 00:10:51,000 --> 00:10:53,480 life, they can still do their work in the mountains. 178 00:10:53,560 --> 00:10:57,600 I remember when when I was in 3rd Special Forces group in 94, 179 00:10:57,600 --> 00:11:01,440 we invaded Haiti and spent six lovely months there. 180 00:11:01,640 --> 00:11:07,040 Every medevac, every one of them was a minor musculoskeletal, 181 00:11:07,240 --> 00:11:09,600 like a twisted ankle. Every every. 182 00:11:09,600 --> 00:11:14,520 We never had a a trauma in that six months. 183 00:11:14,520 --> 00:11:17,000 It was always, oh, here comes the helicopter again, What 184 00:11:17,000 --> 00:11:20,520 happened this time? Sprained knee or eye injury or 185 00:11:20,520 --> 00:11:23,600 something like that. So we need to learn these 186 00:11:23,600 --> 00:11:25,480 basics. Well, I mean, what what makes 187 00:11:25,480 --> 00:11:27,800 Special Forces special? I get asked that and then my 188 00:11:27,800 --> 00:11:30,120 answer is we know the basics well. 189 00:11:30,240 --> 00:11:32,520 And Mick Mack and farm are the basics. 190 00:11:33,600 --> 00:11:36,040 Absolutely. This is this is the basic that 191 00:11:36,040 --> 00:11:40,160 we are more prone to incur in the daily life when we're 192 00:11:40,160 --> 00:11:43,440 working on stereo environment also in cities because people 193 00:11:43,440 --> 00:11:46,800 are falling over and we need to know how to treat them and not 194 00:11:46,800 --> 00:11:50,280 go totally overboard and treat them like a like a trauma case 195 00:11:50,640 --> 00:11:53,120 even because a lot of these people have a lot of pain. 196 00:11:53,120 --> 00:11:56,400 And we think maybe that this is a major trauma, but it's 197 00:11:56,640 --> 00:11:59,600 absolutely something that we can take care of there and then 198 00:11:59,600 --> 00:12:02,920 instead of of rushing the men to a hospital. 199 00:12:03,400 --> 00:12:08,240 So when reviewing the MC Meccan farm, we had 10 years of 200 00:12:08,560 --> 00:12:12,000 feedback from people who've gone through the programme and with 201 00:12:12,000 --> 00:12:15,880 the minor illness course, we removed a couple of items that 202 00:12:15,880 --> 00:12:19,400 wasn't, people found that they weren't applicable and we 203 00:12:19,400 --> 00:12:21,800 updated everything else. And we've added, of course, we 204 00:12:21,800 --> 00:12:27,240 added some in because based on the student feedback on how the 205 00:12:27,360 --> 00:12:32,120 using a student feedback is how we improve the any course in in 206 00:12:32,160 --> 00:12:34,360 the college. But it's the same for this one. 207 00:12:34,360 --> 00:12:37,560 So I, I really enjoyed going through each of these with a 208 00:12:37,560 --> 00:12:41,680 fine tooth comb and upgraded them and enhance them and added 209 00:12:41,720 --> 00:12:46,560 more up to date protocols. So the MIC is focusing on 210 00:12:46,600 --> 00:12:50,720 illnesses and the Mac is focusing on minor injuries. 211 00:12:51,400 --> 00:12:54,800 And I've, I've broken the Mick, the minor illness course down 212 00:12:54,800 --> 00:12:57,480 into systems. So respiratory system, 213 00:12:57,840 --> 00:13:00,760 cardiovascular system, nervous system, gastrointestinal, 214 00:13:00,760 --> 00:13:06,600 gastro, urinary, skin and then I and I did the the field guide at 215 00:13:06,600 --> 00:13:10,760 the same headings and in our quorum field guide is a profound 216 00:13:10,760 --> 00:13:13,760 amount of DNBI that is found here. 217 00:13:13,760 --> 00:13:18,080 So with the illness course, looking at all the respiratory 218 00:13:18,080 --> 00:13:21,960 problems, hay fever, COPD, pneumonia, upper respiratory 219 00:13:21,960 --> 00:13:25,320 tract infection for the cardiovascular, it's So what we, 220 00:13:25,320 --> 00:13:28,680 what we looked at was angina, which is cardiac induced, but we 221 00:13:28,680 --> 00:13:33,280 also looked at musculoskeletal problems that you can have a, 222 00:13:33,360 --> 00:13:36,240 I'm an old guy, I've got lots and lots of arthritis from 223 00:13:36,240 --> 00:13:38,920 carrying a heavy backpack. I get chest pains that are 224 00:13:38,920 --> 00:13:41,560 musculoskeletal. So it differentiates between 225 00:13:41,560 --> 00:13:45,000 angina and musculoskeletal. And with the nervous system, we 226 00:13:45,000 --> 00:13:48,520 talked about headaches, dizziness, insomnia, motion 227 00:13:48,520 --> 00:13:50,320 sickness. People forget about motion 228 00:13:50,320 --> 00:13:52,680 sickness. They, they bring up all these 229 00:13:52,680 --> 00:13:54,960 heavy hitters, Academy and stuff, but they don't bring 230 00:13:54,960 --> 00:13:58,920 meclizine or something that will help with motion sickness and 231 00:13:58,920 --> 00:14:01,680 AGI. We all need to worry about GI 232 00:14:01,680 --> 00:14:05,680 problems because we get deli belly or bacteria in our GI 233 00:14:05,680 --> 00:14:08,480 tract isn't quite used for the food down in Kilimanjaro. 234 00:14:08,880 --> 00:14:13,560 So you might have a bit of a week or two to get used to the, 235 00:14:13,760 --> 00:14:15,440 the food. So having that in there. 236 00:14:15,920 --> 00:14:19,600 And then skin, I mean, tropical dermatology is a whole master's 237 00:14:19,600 --> 00:14:24,640 programme, but we do discuss some of the dermatological 238 00:14:25,160 --> 00:14:27,360 problems that a remote medic would see. 239 00:14:28,040 --> 00:14:31,080 Sorry, no, because I'm just sitting looking at the programme 240 00:14:31,080 --> 00:14:34,880 now and it, we cover almost everything that can occur on the 241 00:14:34,880 --> 00:14:38,680 on the on the basic level, because as you said, to go into 242 00:14:38,680 --> 00:14:42,000 details on Tropical Medicine, we'll then you should do the 243 00:14:42,000 --> 00:14:45,800 DNADTNI mean. But it's like it covers 244 00:14:45,840 --> 00:14:48,880 everything it covers. For example, it covers skin 245 00:14:48,880 --> 00:14:53,960 diseases, dry skin and fungus, how to treat funguses, nail 246 00:14:53,960 --> 00:14:57,080 infections, how to treat warts, scabies, sunburn. 247 00:14:57,120 --> 00:15:00,800 All these things that we really need to know when we are good 248 00:15:00,800 --> 00:15:04,760 medics in austerity environment. Because we can be 3-4 days 249 00:15:05,120 --> 00:15:08,640 without getting the pay the patient or the proper treatment 250 00:15:08,640 --> 00:15:10,720 at the hospital. We need to know what to carry in 251 00:15:10,720 --> 00:15:15,360 the different situation or the different deployment or places 252 00:15:15,360 --> 00:15:17,200 that we're working. Yeah, indeed. 253 00:15:19,000 --> 00:15:21,960 So, so 10 years ago I created the curriculum for the MC Meccan 254 00:15:21,960 --> 00:15:24,000 Farm. And what I did is I looked at 255 00:15:24,000 --> 00:15:28,160 the Wilderness Medical Society and I looked at the JTS and 256 00:15:28,160 --> 00:15:33,400 other published research to see what were the top 20 injuries, 257 00:15:33,840 --> 00:15:38,280 non trauma injuries, what were the top 20 illnesses seen on 258 00:15:38,280 --> 00:15:42,480 expeditions and then what were the top 20 drugs that were used 259 00:15:42,480 --> 00:15:44,800 on expeditions. And and that was the basis for 260 00:15:44,800 --> 00:15:46,880 this and we've developed it since. 261 00:15:46,920 --> 00:15:49,240 Yeah. And I I think going through this 262 00:15:49,240 --> 00:15:52,320 and and the way you put it up with the meme and the Mac and 263 00:15:52,320 --> 00:15:56,880 also putting the farm into this is absolutely great package for 264 00:15:57,200 --> 00:16:00,640 a medic who is going to work alone in an austere environment. 265 00:16:00,760 --> 00:16:03,280 Because if you go through these courses, I think that you will 266 00:16:03,280 --> 00:16:07,560 have a good overview and you will probably also be be more 267 00:16:07,560 --> 00:16:12,040 interested in in going further on and see that this is this is 268 00:16:12,040 --> 00:16:15,120 a lot of things that's not covered in the basic EMT or the 269 00:16:15,120 --> 00:16:18,160 basic self Medicare courses normally, Yeah. 270 00:16:18,400 --> 00:16:22,080 So I've, I've used these three to cover a lot of the primary 271 00:16:22,080 --> 00:16:24,400 care. And what I'm doing with this 272 00:16:24,800 --> 00:16:29,360 relaunch is we're combining all three of these into a package. 273 00:16:29,360 --> 00:16:32,240 Now you can still get these individually because people 274 00:16:32,240 --> 00:16:35,520 might want to just get the MEC and not the making the farm, but 275 00:16:36,120 --> 00:16:38,160 we're going to have something called the APC. 276 00:16:38,240 --> 00:16:40,880 It's the austere primary care package. 277 00:16:41,280 --> 00:16:43,440 And with that is the Meccan farm. 278 00:16:44,040 --> 00:16:47,480 I'm going to throw in some wazoo lectures from around the college 279 00:16:47,480 --> 00:16:51,800 as well to iron out a bit more, more in depth than what the MC 280 00:16:51,800 --> 00:16:54,160 Meccan farm does. So I have lectures that I've 281 00:16:54,160 --> 00:16:56,800 done for the Masters of Austria critical care. 282 00:16:57,120 --> 00:17:00,760 I've got lectures that I've done for the remote paramedic 283 00:17:00,760 --> 00:17:03,560 programme that includes like water procurement and things 284 00:17:03,560 --> 00:17:06,079 like that. And I'm, I'm going to put all of 285 00:17:06,079 --> 00:17:09,839 this into one package so you with just one click can purchase 286 00:17:09,839 --> 00:17:14,160 the APC, the Austria primary care and get the make Mecan form 287 00:17:14,560 --> 00:17:20,400 along with the Abrix top 10 lectures that I've come up with 288 00:17:20,800 --> 00:17:25,720 over the last 10 years. Yeah, and The thing is I'm 289 00:17:25,720 --> 00:17:29,040 actually looking through it now and I have to say it's a great 290 00:17:29,040 --> 00:17:31,480 update. It gives me a lot of new things 291 00:17:31,480 --> 00:17:34,440 also that I need to to know more about, even though I've been 292 00:17:34,720 --> 00:17:39,120 studying this for 30-40 years. But actually I'm going to in a 293 00:17:39,120 --> 00:17:42,160 couple of weeks, I'm going up to the north of Norway teaching for 294 00:17:42,400 --> 00:17:47,080 what we in Norway call the the role one medics. 295 00:17:47,120 --> 00:17:49,520 As you probably know, in Norway, we have the conscription. 296 00:17:50,520 --> 00:17:53,920 So people are going into service for one year and they're 297 00:17:53,920 --> 00:17:56,880 selected. I think it's about 50 people 298 00:17:57,120 --> 00:18:00,320 who's going to be supporting the nurses and the doctors in the 299 00:18:00,320 --> 00:18:02,640 role. Once in the in the base, in the 300 00:18:02,640 --> 00:18:04,680 camps. And I'm throwing in a lot of 301 00:18:04,680 --> 00:18:08,680 these lectures or trying to use a lot of these lectures and 302 00:18:08,680 --> 00:18:12,480 backgrounds to teach these guys how to treat because basically 303 00:18:12,480 --> 00:18:15,400 they're not treating trauma. They are treating people. 304 00:18:15,400 --> 00:18:18,680 They are alone at the night and they have to have the knowledge 305 00:18:18,680 --> 00:18:23,680 and how to treat these diseases and these minor illnesses when 306 00:18:23,680 --> 00:18:27,240 there are alone at the at the role one without calling the 307 00:18:27,240 --> 00:18:30,200 nurses and the doctors not going to give them these courses so 308 00:18:30,200 --> 00:18:34,760 they can actually learn more about these DMI or DNI. 309 00:18:35,240 --> 00:18:38,880 What do you call it? DNDMI is deployed Medicine 310 00:18:38,880 --> 00:18:42,240 international as the John Hagmann which was you and I 311 00:18:42,240 --> 00:18:48,520 first met in at a John Hagmann DMI course and 14 I think it 312 00:18:48,520 --> 00:18:52,720 was. Yeah, it's about South, the MBI. 313 00:18:52,720 --> 00:18:55,360 I'm going to actually talk to you later on how we can 314 00:18:55,360 --> 00:18:59,040 implement this or I can try to implement this for the role one 315 00:18:59,080 --> 00:19:04,760 conscripts working as medics without any formal background, 316 00:19:04,760 --> 00:19:07,120 but they're going to assist the doctors and the nurses in the 317 00:19:07,120 --> 00:19:09,920 Norwegian role one in the camps around in Norway. 318 00:19:10,080 --> 00:19:12,600 And it made me think like, we can put this in Norwegian, but 319 00:19:12,600 --> 00:19:15,960 all you guys speak English anyway, but we should look at 320 00:19:15,960 --> 00:19:19,440 translating this in Ukrainian and giving this free of charge 321 00:19:19,440 --> 00:19:23,600 to anyone on the front lines. Absolutely, because as we've 322 00:19:23,600 --> 00:19:27,040 been teaching trauma in Ukraine now for a couple of years, I 323 00:19:27,080 --> 00:19:29,720 think I think you and I went down to the first time to teach 324 00:19:29,720 --> 00:19:32,800 the, the damage control resuscitation for Ukraine from 325 00:19:32,800 --> 00:19:35,120 plant medics 2 years ago. I think it was the last summer 326 00:19:35,120 --> 00:19:37,400 two years ago. And we also should maybe start 327 00:19:37,400 --> 00:19:42,080 to focusing on these kinds of the DMBI lectures and put up of 328 00:19:42,080 --> 00:19:43,920 course for them. We're actually getting the the 329 00:19:43,920 --> 00:19:47,840 people to Malta to to get some more hands on skills for trauma. 330 00:19:47,840 --> 00:19:51,720 But I think this the MBI also is, is something that we should 331 00:19:51,720 --> 00:19:53,960 focus on. Yeah, and indeed, and I mean, 332 00:19:53,960 --> 00:19:56,640 we're still, we need to focus on the the hitman sheep vomit for 333 00:19:56,640 --> 00:19:59,360 the guys in the front lines and getting the tourniquets 334 00:19:59,360 --> 00:20:01,800 downgraded and getting the infection sorted. 335 00:20:02,160 --> 00:20:06,200 But eventually when they're they're not dealing with trauma, 336 00:20:06,200 --> 00:20:09,320 trauma, trauma, they're going to need austere primary care. 337 00:20:10,800 --> 00:20:14,360 Yeah, and I actually think they need a little bit or knowledge 338 00:20:14,360 --> 00:20:18,200 about it now because as we know there will take maybe days to 339 00:20:18,200 --> 00:20:20,320 get people out from. They're getting out on the 340 00:20:20,320 --> 00:20:23,640 frontline and they are in a stab point or a stabilisation point. 341 00:20:23,640 --> 00:20:25,960 And we have diseases and illnesses. 342 00:20:25,960 --> 00:20:29,720 It could, as you know, people are not the young ones always. 343 00:20:29,720 --> 00:20:32,400 It's could be the old ones. And they need to know more about 344 00:20:32,400 --> 00:20:36,560 normal diseases like heart problems, like respiratory 345 00:20:36,560 --> 00:20:39,720 problems and respiratory problems is also something that 346 00:20:39,720 --> 00:20:44,680 they have quite, quite a lot of in, in Ukraine also and also in 347 00:20:44,880 --> 00:20:48,600 other places that we are now involved in, in conflicts. 348 00:20:48,760 --> 00:20:51,680 But I'm, I'm glad you brought that up because if you look at 349 00:20:51,680 --> 00:20:55,880 tuberculosis, it's rampant on the other side, but it's also 350 00:20:55,880 --> 00:20:59,160 rampant. I mean, it, there's too much TB 351 00:20:59,280 --> 00:21:01,880 in the front lines of Ukraine and that's they're, they're, 352 00:21:02,920 --> 00:21:04,880 they can't be blamed, in all fairness, because they're 353 00:21:04,880 --> 00:21:07,840 working in really difficult environments and they're not, 354 00:21:07,840 --> 00:21:09,440 it's cold. So you're going to have everyone 355 00:21:09,440 --> 00:21:12,480 that you can into to 1 enclosed area. 356 00:21:12,480 --> 00:21:15,040 So TB is a problem. I think they're handling it 357 00:21:15,040 --> 00:21:16,520 better than the other guys, thankfully. 358 00:21:16,560 --> 00:21:18,360 Yeah, that's a DNBI issue, isn't it? 359 00:21:19,200 --> 00:21:23,200 Yeah, absolutely. And we also see that in Norway, 360 00:21:23,200 --> 00:21:26,480 because the conflicts are actually making more people. 361 00:21:26,520 --> 00:21:29,760 Well, we get a big refugee situation around the world now 362 00:21:29,760 --> 00:21:34,160 and people are coming from areas where TBI is a big issue and 363 00:21:34,160 --> 00:21:37,600 they are coming to places like Norway where we actually didn't 364 00:21:37,600 --> 00:21:41,000 have it, but now we see an increased number of people with 365 00:21:41,000 --> 00:21:41,640 it. That's true. 366 00:21:41,640 --> 00:21:44,360 I hadn't thought about that. The the migration is bringing 367 00:21:44,360 --> 00:21:46,120 these respiratory issues with them. 368 00:21:46,520 --> 00:21:48,280 Yeah, and also the tropical diseases. 369 00:21:49,560 --> 00:21:51,840 As a, as a trop Med, I, I guess I can't actually have a 370 00:21:51,840 --> 00:21:54,760 discretion anywhere without breaking up trop Med and, and 371 00:21:54,760 --> 00:21:56,720 you're, you're ADTN graduate as well. 372 00:21:56,960 --> 00:22:02,440 So it's interesting to see the, the minor illness course should 373 00:22:02,440 --> 00:22:06,320 cover tropical diseases because we're seeing local transmission 374 00:22:06,320 --> 00:22:11,600 of tropical diseases in mainland Europe and also in Florida and 375 00:22:11,600 --> 00:22:13,440 Texas. And it's just a matter of time 376 00:22:14,000 --> 00:22:18,400 before we think everyone's going to need a Mick course because of 377 00:22:18,400 --> 00:22:21,120 global warming is pushing these diseases in the North. 378 00:22:21,720 --> 00:22:24,960 Yeah, absolutely. And to quote our good friend 379 00:22:24,960 --> 00:22:29,120 Jason Jarvis, fever without any known origin or you don't know 380 00:22:29,120 --> 00:22:31,480 why the what's causes the fever? It's malaria. 381 00:22:32,360 --> 00:22:35,360 That's not true for Norway, basically, But what I learned, I 382 00:22:35,360 --> 00:22:38,000 also work as a paramedic for a community health service, 383 00:22:38,000 --> 00:22:41,000 driving doctors to, to patient who can come to the doctor's 384 00:22:41,000 --> 00:22:42,880 office. And what I learned the doctors 385 00:22:42,880 --> 00:22:47,560 now last years is that if they have a fever and there's no 386 00:22:47,560 --> 00:22:53,200 elevation in the, in the, in the infection, measuring the CRP, 387 00:22:53,280 --> 00:22:57,200 then we should ask the patient, have you been travelled? 388 00:22:57,480 --> 00:23:00,240 Have you been to Africa? And I had actually one patient 389 00:23:00,240 --> 00:23:03,960 with a fever who just two weeks ago came from Africa. 390 00:23:04,480 --> 00:23:06,960 This is why we have the R in sampler. 391 00:23:06,960 --> 00:23:09,080 R is recent travel. Yep. 392 00:23:10,160 --> 00:23:13,200 And I think we need to to think more about that in the in the 393 00:23:13,200 --> 00:23:17,000 coming years that people are more mobile, we have refugees, 394 00:23:17,000 --> 00:23:21,200 we have people flying all over and they've been on holidays in 395 00:23:21,240 --> 00:23:24,480 places where there are different infections and different 396 00:23:24,480 --> 00:23:27,760 diseases that we are normally used to see in in other 397 00:23:27,760 --> 00:23:29,920 countries. So one more reason to take the 398 00:23:29,920 --> 00:23:34,040 MEC and form Absolutely. So as we move forward, as we do 399 00:23:34,040 --> 00:23:38,680 the official launch of and the rebranding of the make Mac and 400 00:23:38,680 --> 00:23:45,120 Farm into the APC, the austere primary care, we are going to 401 00:23:45,120 --> 00:23:47,600 need to add a bit of trot Med there as well. 402 00:23:47,600 --> 00:23:52,280 And we will, because it is a DNBI issue, tropical diseases, 403 00:23:53,200 --> 00:23:56,000 but we are focusing these for the remote medic. 404 00:23:56,000 --> 00:23:59,760 And when we say remote medic, we're talking about what we have 405 00:23:59,760 --> 00:24:02,880 graduates who are doing the offshore industry such as wind 406 00:24:02,880 --> 00:24:07,240 farms or oil rigs, expeditions. We have people go on a 407 00:24:07,240 --> 00:24:11,560 humanitarian missions and remote sites and of course soft medics. 408 00:24:11,560 --> 00:24:14,200 We have quite a few graduates and people going through our 409 00:24:14,200 --> 00:24:19,000 programmes who are soft or soft support and this is what we 410 00:24:19,000 --> 00:24:23,720 design these for is for those of you working in remote, austere 411 00:24:23,720 --> 00:24:25,960 and resource limited environments at will. 412 00:24:25,960 --> 00:24:30,360 The whole nonprofit I founded, Quorum, with the whole concept 413 00:24:30,360 --> 00:24:36,600 of we need to bring academic backing for all these these, for 414 00:24:36,600 --> 00:24:39,120 all these medics working in difficult environments. 415 00:24:40,400 --> 00:24:43,960 Yeah, absolutely, absolutely. I think that every medic should, 416 00:24:44,520 --> 00:24:48,200 should focus on that these courses also and not only on 417 00:24:48,200 --> 00:24:51,640 trauma, but yeah, I think this is going to be a great course. 418 00:24:51,640 --> 00:24:54,800 And by the way, the tropical diseases, we should also cover 419 00:24:54,800 --> 00:24:57,960 some of the tropical diseases. But when we have finished 420 00:24:57,960 --> 00:25:00,800 because we are also working on the new tropical travel and 421 00:25:00,800 --> 00:25:04,400 expedition in medicine course that is online course that you 422 00:25:04,400 --> 00:25:06,880 can take. But it's also five day course in 423 00:25:06,880 --> 00:25:11,000 Malta that we are running where you get exposed for how to find 424 00:25:11,000 --> 00:25:13,560 out what kind of diseases, tropical diseases you have. 425 00:25:13,560 --> 00:25:18,040 You have a lot of microscopy and also we go through all these 426 00:25:18,040 --> 00:25:24,120 normal, the major illnesses and also the major bugs and snakes 427 00:25:24,120 --> 00:25:28,160 and whatever you have that is not normal in many other places. 428 00:25:29,360 --> 00:25:33,760 So yeah, the next thing on the chopping block for upgrading and 429 00:25:33,760 --> 00:25:38,080 enhancing is the T TAMS Online and the Tropical Travel 430 00:25:38,080 --> 00:25:40,960 Expedition Medicine. So these students coming from 431 00:25:40,960 --> 00:25:44,440 around the world that are coming for the hands on TTMS can have a 432 00:25:44,440 --> 00:25:46,920 bit of e-learning before they arrive. 433 00:25:46,920 --> 00:25:50,280 For for anyone who wants the e-learning who won't be coming 434 00:25:50,360 --> 00:25:54,360 to a Pretty Bay Malta, you'll still have a chance to learn the 435 00:25:54,360 --> 00:25:56,720 quorum way of looking at tropical diseases. 436 00:25:57,800 --> 00:26:01,000 I think that's actually I will, I will strongly recommend that 437 00:26:01,000 --> 00:26:05,400 course to do that course just for see how many things that you 438 00:26:05,400 --> 00:26:07,960 probably don't know about. And then you probably get 439 00:26:07,960 --> 00:26:11,240 encouraged to do go to the to the to London School of Tropical 440 00:26:11,240 --> 00:26:14,840 Hygiene Medicine, which is I think it's a four months course 441 00:26:14,840 --> 00:26:18,440 and mostly it's online. So this is a great course. 442 00:26:19,760 --> 00:26:22,760 So we're coming back to the whole DTN thing and I'm kind of 443 00:26:22,760 --> 00:26:24,880 glad we are. Kind of wraps the bundle and 444 00:26:24,880 --> 00:26:27,160 makes a nice little bow tie on top of the box. 445 00:26:27,760 --> 00:26:31,680 The DTN programme is online only, but you can supplement 446 00:26:31,680 --> 00:26:35,360 that as Eric and I both have done by going to either 447 00:26:35,360 --> 00:26:38,720 Liverpool or London and do a microscopy course. 448 00:26:38,960 --> 00:26:42,000 So once you finish your DTN online, you get your DTN and it 449 00:26:42,040 --> 00:26:45,160 makes you a better medic. But until you get that hand 450 00:26:45,160 --> 00:26:48,640 knowledge of spending three days with a microscope, looking at 451 00:26:48,640 --> 00:26:52,160 all these we beasties under the, the microscope and the slides 452 00:26:52,160 --> 00:26:55,640 and, and learning how to, to make slides and, and how to 453 00:26:55,640 --> 00:26:58,240 stain slides. So, so last summer, Eric, that 454 00:26:58,240 --> 00:27:00,400 was a first for you, wasn't it? I've I've done of these a few 455 00:27:00,400 --> 00:27:04,960 times, but how was it for you to have the hands on at London? 456 00:27:05,920 --> 00:27:08,040 Well, it was great. It was absolutely great because 457 00:27:08,040 --> 00:27:11,480 what I was lacking from the online portion that when I did 458 00:27:11,480 --> 00:27:14,840 the DTN was that it's, it's, it's a very good course. 459 00:27:14,840 --> 00:27:17,960 It was very good teachers. But the thing I couldn't, I was 460 00:27:17,960 --> 00:27:20,280 sitting at home and I was looking at picture of 461 00:27:20,480 --> 00:27:24,640 microscopes and videos on how to make slides. 462 00:27:25,080 --> 00:27:27,600 But The thing is when it will go into London with you for the 463 00:27:27,600 --> 00:27:29,800 three day course was absolutely amazing. 464 00:27:30,000 --> 00:27:33,080 We were sitting from the morning to the afternoon looking at 465 00:27:33,080 --> 00:27:36,640 different slides, making slides and doing samples and all that 466 00:27:36,640 --> 00:27:41,440 stuff, so it was absolutely great benefit for me and 467 00:27:41,560 --> 00:27:44,400 contribution to know more about tropical diseases. 468 00:27:44,440 --> 00:27:47,760 Yeah, so that slide course I've done three Times Now, I've done 469 00:27:47,760 --> 00:27:52,080 once in Liverpool and twice and London and every time I go I, I 470 00:27:52,080 --> 00:27:54,200 learn something. So it's just for me having that 471 00:27:54,200 --> 00:27:55,560 head knowledge is lovely, of course. 472 00:27:55,560 --> 00:27:59,160 But until I get that into my hand and knowledge, I, I just 473 00:27:59,160 --> 00:28:03,920 don't think I have it as as deeply and and, and strongly as, 474 00:28:04,000 --> 00:28:08,120 as I want to have the knowledge. So that's, I highly suggest that 475 00:28:08,120 --> 00:28:12,000 anyone who wants to better themselves as a medic, well, 476 00:28:12,000 --> 00:28:14,720 first do the deed. But then, yeah, talk to me or 477 00:28:14,720 --> 00:28:17,360 talk to Eric about the microscopy course. 478 00:28:18,160 --> 00:28:22,120 Yeah, because just just learning how to use the microscope is is 479 00:28:22,360 --> 00:28:24,960 it's not depending on the microscope you have. 480 00:28:25,040 --> 00:28:28,640 We in Malta, we use the the small ones, the portable ones. 481 00:28:28,640 --> 00:28:31,080 But if you have access to the big ones, it's really nice to 482 00:28:31,080 --> 00:28:35,000 know how to turn it on, how to adjust it and how to get the 483 00:28:35,000 --> 00:28:38,160 best image of it and how to actually look at the slide. 484 00:28:38,160 --> 00:28:41,440 How are you manoeuvring the slide in the microscope and 485 00:28:41,440 --> 00:28:44,880 knowing where you're at and how to actually investigate the 486 00:28:44,880 --> 00:28:48,280 things that you're looking at? In, in Malta, we have the Newton 487 00:28:48,400 --> 00:28:53,720 microscope, which gets you about 900 X is made in, in Japan and 488 00:28:53,720 --> 00:28:57,200 made in England. It's, it's OK and, and most 489 00:28:57,760 --> 00:29:01,400 microscopists will refuse to acknowledge anything under 1000 490 00:29:01,400 --> 00:29:04,160 X because that's when you go and, and use oil immersion. 491 00:29:04,640 --> 00:29:07,560 But we use them in a classroom and you can't differentiate 492 00:29:07,560 --> 00:29:09,920 malaria. And you can see, of course, the 493 00:29:09,960 --> 00:29:11,720 helmets swimming around in the blood. 494 00:29:12,360 --> 00:29:14,640 We train on those because that's what you're going to have in the 495 00:29:14,640 --> 00:29:17,480 field. You're not going to bring a huge 496 00:29:17,480 --> 00:29:20,640 desktop microscope into a jungle ICU. 497 00:29:20,640 --> 00:29:23,560 So that is. And we use the smartphone ones 498 00:29:23,560 --> 00:29:26,200 as well, but those only go up to 400 X watch. 499 00:29:26,200 --> 00:29:29,800 So we've deviated a bit, Eric, from our concept of MC mech and 500 00:29:29,800 --> 00:29:34,320 farm going into a passion of trop, trop Med, which does fall 501 00:29:34,320 --> 00:29:35,880 under DNBII. Get it? 502 00:29:36,240 --> 00:29:40,320 Yeah, I'm sorry for that. It's a passion. 503 00:29:41,280 --> 00:29:45,680 It is definitely a passion. So I encourage you to see the 504 00:29:45,680 --> 00:29:49,160 new APC, the Austria primary care module that we have up and 505 00:29:49,160 --> 00:29:53,480 running on our website. Or you can purchase the Mick 506 00:29:53,480 --> 00:29:57,240 Mack and farm individually and you still get some really good 507 00:29:57,240 --> 00:29:58,440 learning. But if you want the full 508 00:29:58,440 --> 00:30:03,600 package, the APC is now live and I look forward to hearing the 509 00:30:03,600 --> 00:30:06,880 feedback from people going through it because in four or 510 00:30:06,880 --> 00:30:11,520 five years we're going to read those and improve what we're 511 00:30:11,760 --> 00:30:14,840 what we've just created. Absolutely. 512 00:30:14,920 --> 00:30:18,280 And if there's any questions, just to reach out to the Quorum 513 00:30:18,280 --> 00:30:21,280 website and and we will answer any of your questions. 514 00:30:22,560 --> 00:30:25,600 Yeah, we look forward to seeing how you like the new programme 515 00:30:25,680 --> 00:30:27,560 and we'll see you next week. Thank you. 516 00:30:28,800 --> 00:30:32,560 This has been a presentation from the College of Remote and 517 00:30:32,560 --> 00:30:35,680 Offshore Medicine. If you would like to earn CPD 518 00:30:35,680 --> 00:30:39,600 credits for this podcast, you can join the Council of members. 519 00:30:39,960 --> 00:30:43,800 Being a member of the College gives you free CPD credit, free 520 00:30:43,840 --> 00:30:47,000 access for a virtual field guide, and discounts on our 521 00:30:47,000 --> 00:30:50,160 e-learning courses. You can join the team on our 522 00:30:50,160 --> 00:30:54,400 College website at quorum.edu dot Mt.