Hello everyone and welcome to the Quorum podcast.
This is where academic medicine meets remote, austere and
resource limited areas. Welcome back to the podcast,
this is Avacol Kelly. This week we are again joined by
Eric Holmstrom, who is the Director of our CPD programmes
at the College and has been on our faculty for almost a decade
now. Eric, welcome back to the.
Programme. Thank you, Eric.
It's good to be back again. So, Eric, tell the listeners
what exactly you do for Quorum. So basically I'm supervising and
organising the CPD courses, the online courses at our website.
So I follow up students who have any questions or any technical
issues and try to sort that out. And I also manage all the
practical courses at our location in Malta.
Register the students when I get them from the registrar and make
sure that they get the information that they need to
join us down in Malta. And making all the planning and
preparation for the courses for the bachelor students, the
master students and also for the CPD students who want to do a
practical training in Malta. So part of that is you run the
online CPD programmes, which is the the MC, MC and farm was was
the first three. They were the first three that
we started. We've we've had more online
programmes join the 1st 3. But today we're going to talk
about the MC, the minor illness course, MC, the minor
emergencies course and the farm, which is pharmacology for the
remote medics. And Eric, you and I have just
upgraded them. We've, we did a complete
rewrite, redesign audit of what we had before and we've updated
it and now it's launching. Yeah.
As you said, Rick, the first, these first courses, I think
they were started about 10-12 years ago where we put them on
and they were actually quite well appreciated by the students
and they've been upgraded sometimes according to new
protocol, new routines and new treatments.
But now we actually have taken those three courses and totally
renewed them. And we're also putting on a new
platform that has more potential.
And I think that the the launch that I think we're going to have
on Monday next week is going to be awesome.
And the the students who want to look into them will see that
this is a total renewal of those 3 programmes.
Yeah, so they go together. We, we created these as a
package deal focusing on disease and non battle injuries, what we
called it in the military. But I think minor illness, minor
emergencies, primary care, general practise, that kind of
stuff. And there's tonnes of other CPD
online programmes out there that focus on minor emergencies,
minor illnesses and pharmacology.
But we did something well, we always do something different.
We focused on the remote medic. So drawing on a lot of your
background, Eric and special OPS as well as teaching in the
NSOCUM course. So you you were running the
curriculum for the Nsocum course for a while.
What Dnbi topics were you teaching in Fullendorf, Germany?
Well, basically the, the second course was built on, it's
basically mostly trauma medicine and prolonged field care.
But we also implemented these three topics that the minor
illness and the minor emergency and the pharmacology.
Because when we're talking a lot about trauma today and that
that's understandable because the world is a more dangerous
place and we have more the wars going on than we had before.
So we mustn't lose focus on the normal things that EMTs in the
austere environment can actually actually incur.
And that was also one of the points in the sub course because
the soldier has to take care of themselves when they are in a
FOB or on patrol. And it could happen that they
have illnesses or they have minor emergency like ankle
sprains or toothaches or whatever you have.
And one of the other things that's important that we focus a
lot on the ENSOCOM is the pharmacology module because what
we know is that pharmacology is something that people struggle
with. We've we've seen that on several
of our practical courses, especially when it comes to
calculation. And I think that knowing more
about pharmacology, knowing more about minor emergency that is
not directly trauma and also about illnesses like diseases
like fever, like headache and all these things that doesn't
necessarily need commitment into the hospitals.
I think that's a thing that all austere and remote paramedics
should know about. That was the original reason
that Quorum was invited into the NATO special operations combat
medic course because we brought in this disease and non battle
injury type thing. So we we ran with designed and
ran the Trot Med week which included all sorts of illnesses
and minor emergencies as well as as this pharmacology to cover
that there was very little trauma in that week.
And I think, and Sockham is still running the curriculum,
what we created to bring in a bit of the Dnbi.
So for those of you who don't know what Dnbi is, is disease
and non battle injury. It's it's it's an army term that
someone came up with ages ago because throughout history, more
people in the military and military conflict died from
diseases and non battle injuries than ever died from combat.
It wasn't until we got the hand washing sorted with, with
Semmelweis in 18641865 that we, we found that for the first time
in history, fewer combatants were dying from non trauma as
World War One was the big testing ground for this new
concept of preventative care. And then now 150 years later, we
are doing very well with DMBI. But we still, because who we
are, we're SF mentality, you and I and and we just love trauma,
trauma, trauma. And we still have to realise the
majority of the things that we see on an operational setting
are is not trauma. Yeah, because that's what when
you guys come down to Fullndorf to to help us out with that and
how the the topics of tropical diseases.
I was thinking about OK, tropical diseases, that's just a
small portion, especially for me coming from Norway, we don't
have a lot of tropical diseases. We are focused more on
hypothermia and and those kinds of things.
But what I learned from you guys, and that's also the reason
why I went to London School of Tropical and Hygiene to do the
course there, because it's not only so tropical diseases is
actually minor illnesses course also because a lot of the
tropical diseases will put people out of operation if they
cannot mitigate or they cannot prepare for that.
So when you taught that tropical tropical portion of the second
course, I learned a lot about minor emergencies and also minor
illnesses and also a lot of pharmacology because that goes
also into pharmacology. What kind of drugs do I need if
I go to a tropical area? I need to know more about those
and that's why I thought that this MIM, MEC and Pharma modules
that we have created is actually a great add on to to people
who's working in austerity environments.
I'm glad you mentioned the DTN programme.
The Diploma of Tropical Nursing from London School of Hygiene
and Tropical Medicine and Liverpool has one as well so
every medic should have this. If you're a military medic,
operational medic, paramedic, or nurse, don't get your DTN
because it covers these in such an extreme detail that it made
me a better medic. Absolutely.
I'm second that one because I learned a lot when I went to the
DTN and also it made me think much about more preventive
medicine and how we can avoid. And this is what this course is
also covers is how can we prepare for tropical
deployments? How can we make sure that we
have the right vaccination? How can we prepare the camps?
The easiest thing to to think about is what about our
senatorial problems in austerity environment?
We had an incident in deployment to Afghanistan within Norwegian.
We put up a new camp in Masare Sharif and we didn't prep good
enough, so we got a lot of diseases because the ground was
full of rats and snakes and whatever you have.
So we had to actually excavate all the grounds, do it again.
So in this camp we had a big outbreak of leishmaniasis
because or not the big, but we got some, some soldiers who was
bitten by this little sand fly. So we learned how to prevent
ourselves for this. And also we had a big outbreak.
And now because of hand sanitation in the, in the
kitchen, we had the 100 people in, in the hospitalised because
of the dehydration. So we also had a lot of people.
Actually we had at 100 people, I think it was in, in beds having
the shooter and diarrhoea because we found out that on the
kitchen, the kitchen stuff didn't wash their hands good
enough. So it infected the entire camp.
And we had 100 people in bed in, in a tent that we had to put IV
fluids on everybody. And they were they, they were
not feeling happy. So this is things that these
courses also cover. Yeah, we we hit diarrhoea quite
heavily. It's one of the five mad at
diseases, the top five tropical diseases that will affect a
casualty. We spend a lot of time on the
our field guide about that and hydration ladder.
I just published something on LinkedIn about the hydration
ladder to keep someone from from dying of this disease that you
had. Yeah, and and also talking about
the minor emergency course in my years, I have a 30-40 years in
the pre hospital space. Now what I see in the civilian
ambulances in the austerity environment is we don't have a
lot of trauma or we have minor trauma that can be fixed without
without sending the patient to the to the hospital.
And I think that the neck is acts absolutely perfect for
people who want to learn more about ankle sprain, how to to
fix toothaches, house to fix headaches and things.
That is not necessarily that you have to send the people to a
hospital, but they can still do the mission or if in a civilian
life, they can still do their work in the mountains.
I remember when when I was in 3rd Special Forces group in 94,
we invaded Haiti and spent six lovely months there.
Every medevac, every one of them was a minor musculoskeletal,
like a twisted ankle. Every every.
We never had a a trauma in that six months.
It was always, oh, here comes the helicopter again, What
happened this time? Sprained knee or eye injury or
something like that. So we need to learn these
basics. Well, I mean, what what makes
Special Forces special? I get asked that and then my
answer is we know the basics well.
And Mick Mack and farm are the basics.
Absolutely. This is this is the basic that
we are more prone to incur in the daily life when we're
working on stereo environment also in cities because people
are falling over and we need to know how to treat them and not
go totally overboard and treat them like a like a trauma case
even because a lot of these people have a lot of pain.
And we think maybe that this is a major trauma, but it's
absolutely something that we can take care of there and then
instead of of rushing the men to a hospital.
So when reviewing the MC Meccan farm, we had 10 years of
feedback from people who've gone through the programme and with
the minor illness course, we removed a couple of items that
wasn't, people found that they weren't applicable and we
updated everything else. And we've added, of course, we
added some in because based on the student feedback on how the
using a student feedback is how we improve the any course in in
the college. But it's the same for this one.
So I, I really enjoyed going through each of these with a
fine tooth comb and upgraded them and enhance them and added
more up to date protocols. So the MIC is focusing on
illnesses and the Mac is focusing on minor injuries.
And I've, I've broken the Mick, the minor illness course down
into systems. So respiratory system,
cardiovascular system, nervous system, gastrointestinal,
gastro, urinary, skin and then I and I did the the field guide at
the same headings and in our quorum field guide is a profound
amount of DNBI that is found here.
So with the illness course, looking at all the respiratory
problems, hay fever, COPD, pneumonia, upper respiratory
tract infection for the cardiovascular, it's So what we,
what we looked at was angina, which is cardiac induced, but we
also looked at musculoskeletal problems that you can have a,
I'm an old guy, I've got lots and lots of arthritis from
carrying a heavy backpack. I get chest pains that are
musculoskeletal. So it differentiates between
angina and musculoskeletal. And with the nervous system, we
talked about headaches, dizziness, insomnia, motion
sickness. People forget about motion
sickness. They, they bring up all these
heavy hitters, Academy and stuff, but they don't bring
meclizine or something that will help with motion sickness and
AGI. We all need to worry about GI
problems because we get deli belly or bacteria in our GI
tract isn't quite used for the food down in Kilimanjaro.
So you might have a bit of a week or two to get used to the,
the food. So having that in there.
And then skin, I mean, tropical dermatology is a whole master's
programme, but we do discuss some of the dermatological
problems that a remote medic would see.
Sorry, no, because I'm just sitting looking at the programme
now and it, we cover almost everything that can occur on the
on the on the basic level, because as you said, to go into
details on Tropical Medicine, we'll then you should do the
DNADTNI mean. But it's like it covers
everything it covers. For example, it covers skin
diseases, dry skin and fungus, how to treat funguses, nail
infections, how to treat warts, scabies, sunburn.
All these things that we really need to know when we are good
medics in austerity environment. Because we can be 3-4 days
without getting the pay the patient or the proper treatment
at the hospital. We need to know what to carry in
the different situation or the different deployment or places
that we're working. Yeah, indeed.
So, so 10 years ago I created the curriculum for the MC Meccan
Farm. And what I did is I looked at
the Wilderness Medical Society and I looked at the JTS and
other published research to see what were the top 20 injuries,
non trauma injuries, what were the top 20 illnesses seen on
expeditions and then what were the top 20 drugs that were used
on expeditions. And and that was the basis for
this and we've developed it since.
Yeah. And I I think going through this
and and the way you put it up with the meme and the Mac and
also putting the farm into this is absolutely great package for
a medic who is going to work alone in an austere environment.
Because if you go through these courses, I think that you will
have a good overview and you will probably also be be more
interested in in going further on and see that this is this is
a lot of things that's not covered in the basic EMT or the
basic self Medicare courses normally, Yeah.
So I've, I've used these three to cover a lot of the primary
care. And what I'm doing with this
relaunch is we're combining all three of these into a package.
Now you can still get these individually because people
might want to just get the MEC and not the making the farm, but
we're going to have something called the APC.
It's the austere primary care package.
And with that is the Meccan farm.
I'm going to throw in some wazoo lectures from around the college
as well to iron out a bit more, more in depth than what the MC
Meccan farm does. So I have lectures that I've
done for the Masters of Austria critical care.
I've got lectures that I've done for the remote paramedic
programme that includes like water procurement and things
like that. And I'm, I'm going to put all of
this into one package so you with just one click can purchase
the APC, the Austria primary care and get the make Mecan form
along with the Abrix top 10 lectures that I've come up with
over the last 10 years. Yeah, and The thing is I'm
actually looking through it now and I have to say it's a great
update. It gives me a lot of new things
also that I need to to know more about, even though I've been
studying this for 30-40 years. But actually I'm going to in a
couple of weeks, I'm going up to the north of Norway teaching for
what we in Norway call the the role one medics.
As you probably know, in Norway, we have the conscription.
So people are going into service for one year and they're
selected. I think it's about 50 people
who's going to be supporting the nurses and the doctors in the
role. Once in the in the base, in the
camps. And I'm throwing in a lot of
these lectures or trying to use a lot of these lectures and
backgrounds to teach these guys how to treat because basically
they're not treating trauma. They are treating people.
They are alone at the night and they have to have the knowledge
and how to treat these diseases and these minor illnesses when
there are alone at the at the role one without calling the
nurses and the doctors not going to give them these courses so
they can actually learn more about these DMI or DNI.
What do you call it? DNDMI is deployed Medicine
international as the John Hagmann which was you and I
first met in at a John Hagmann DMI course and 14 I think it
was. Yeah, it's about South, the MBI.
I'm going to actually talk to you later on how we can
implement this or I can try to implement this for the role one
conscripts working as medics without any formal background,
but they're going to assist the doctors and the nurses in the
Norwegian role one in the camps around in Norway.
And it made me think like, we can put this in Norwegian, but
all you guys speak English anyway, but we should look at
translating this in Ukrainian and giving this free of charge
to anyone on the front lines. Absolutely, because as we've
been teaching trauma in Ukraine now for a couple of years, I
think I think you and I went down to the first time to teach
the, the damage control resuscitation for Ukraine from
plant medics 2 years ago. I think it was the last summer
two years ago. And we also should maybe start
to focusing on these kinds of the DMBI lectures and put up of
course for them. We're actually getting the the
people to Malta to to get some more hands on skills for trauma.
But I think this the MBI also is, is something that we should
focus on. Yeah, and indeed, and I mean,
we're still, we need to focus on the the hitman sheep vomit for
the guys in the front lines and getting the tourniquets
downgraded and getting the infection sorted.
But eventually when they're they're not dealing with trauma,
trauma, trauma, they're going to need austere primary care.
Yeah, and I actually think they need a little bit or knowledge
about it now because as we know there will take maybe days to
get people out from. They're getting out on the
frontline and they are in a stab point or a stabilisation point.
And we have diseases and illnesses.
It could, as you know, people are not the young ones always.
It's could be the old ones. And they need to know more about
normal diseases like heart problems, like respiratory
problems and respiratory problems is also something that
they have quite, quite a lot of in, in Ukraine also and also in
other places that we are now involved in, in conflicts.
But I'm, I'm glad you brought that up because if you look at
tuberculosis, it's rampant on the other side, but it's also
rampant. I mean, it, there's too much TB
in the front lines of Ukraine and that's they're, they're,
they can't be blamed, in all fairness, because they're
working in really difficult environments and they're not,
it's cold. So you're going to have everyone
that you can into to 1 enclosed area.
So TB is a problem. I think they're handling it
better than the other guys, thankfully.
Yeah, that's a DNBI issue, isn't it?
Yeah, absolutely. And we also see that in Norway,
because the conflicts are actually making more people.
Well, we get a big refugee situation around the world now
and people are coming from areas where TBI is a big issue and
they are coming to places like Norway where we actually didn't
have it, but now we see an increased number of people with
it. That's true.
I hadn't thought about that. The the migration is bringing
these respiratory issues with them.
Yeah, and also the tropical diseases.
As a, as a trop Med, I, I guess I can't actually have a
discretion anywhere without breaking up trop Med and, and
you're, you're ADTN graduate as well.
So it's interesting to see the, the minor illness course should
cover tropical diseases because we're seeing local transmission
of tropical diseases in mainland Europe and also in Florida and
Texas. And it's just a matter of time
before we think everyone's going to need a Mick course because of
global warming is pushing these diseases in the North.
Yeah, absolutely. And to quote our good friend
Jason Jarvis, fever without any known origin or you don't know
why the what's causes the fever? It's malaria.
That's not true for Norway, basically, But what I learned, I
also work as a paramedic for a community health service,
driving doctors to, to patient who can come to the doctor's
office. And what I learned the doctors
now last years is that if they have a fever and there's no
elevation in the, in the, in the infection, measuring the CRP,
then we should ask the patient, have you been travelled?
Have you been to Africa? And I had actually one patient
with a fever who just two weeks ago came from Africa.
This is why we have the R in sampler.
R is recent travel. Yep.
And I think we need to to think more about that in the in the
coming years that people are more mobile, we have refugees,
we have people flying all over and they've been on holidays in
places where there are different infections and different
diseases that we are normally used to see in in other
countries. So one more reason to take the
MEC and form Absolutely. So as we move forward, as we do
the official launch of and the rebranding of the make Mac and
Farm into the APC, the austere primary care, we are going to
need to add a bit of trot Med there as well.
And we will, because it is a DNBI issue, tropical diseases,
but we are focusing these for the remote medic.
And when we say remote medic, we're talking about what we have
graduates who are doing the offshore industry such as wind
farms or oil rigs, expeditions. We have people go on a
humanitarian missions and remote sites and of course soft medics.
We have quite a few graduates and people going through our
programmes who are soft or soft support and this is what we
design these for is for those of you working in remote, austere
and resource limited environments at will.
The whole nonprofit I founded, Quorum, with the whole concept
of we need to bring academic backing for all these these, for
all these medics working in difficult environments.
Yeah, absolutely, absolutely. I think that every medic should,
should focus on that these courses also and not only on
trauma, but yeah, I think this is going to be a great course.
And by the way, the tropical diseases, we should also cover
some of the tropical diseases. But when we have finished
because we are also working on the new tropical travel and
expedition in medicine course that is online course that you
can take. But it's also five day course in
Malta that we are running where you get exposed for how to find
out what kind of diseases, tropical diseases you have.
You have a lot of microscopy and also we go through all these
normal, the major illnesses and also the major bugs and snakes
and whatever you have that is not normal in many other places.
So yeah, the next thing on the chopping block for upgrading and
enhancing is the T TAMS Online and the Tropical Travel
Expedition Medicine. So these students coming from
around the world that are coming for the hands on TTMS can have a
bit of e-learning before they arrive.
For for anyone who wants the e-learning who won't be coming
to a Pretty Bay Malta, you'll still have a chance to learn the
quorum way of looking at tropical diseases.
I think that's actually I will, I will strongly recommend that
course to do that course just for see how many things that you
probably don't know about. And then you probably get
encouraged to do go to the to the to London School of Tropical
Hygiene Medicine, which is I think it's a four months course
and mostly it's online. So this is a great course.
So we're coming back to the whole DTN thing and I'm kind of
glad we are. Kind of wraps the bundle and
makes a nice little bow tie on top of the box.
The DTN programme is online only, but you can supplement
that as Eric and I both have done by going to either
Liverpool or London and do a microscopy course.
So once you finish your DTN online, you get your DTN and it
makes you a better medic. But until you get that hand
knowledge of spending three days with a microscope, looking at
all these we beasties under the, the microscope and the slides
and, and learning how to, to make slides and, and how to
stain slides. So, so last summer, Eric, that
was a first for you, wasn't it? I've I've done of these a few
times, but how was it for you to have the hands on at London?
Well, it was great. It was absolutely great because
what I was lacking from the online portion that when I did
the DTN was that it's, it's, it's a very good course.
It was very good teachers. But the thing I couldn't, I was
sitting at home and I was looking at picture of
microscopes and videos on how to make slides.
But The thing is when it will go into London with you for the
three day course was absolutely amazing.
We were sitting from the morning to the afternoon looking at
different slides, making slides and doing samples and all that
stuff, so it was absolutely great benefit for me and
contribution to know more about tropical diseases.
Yeah, so that slide course I've done three Times Now, I've done
once in Liverpool and twice and London and every time I go I, I
learn something. So it's just for me having that
head knowledge is lovely, of course.
But until I get that into my hand and knowledge, I, I just
don't think I have it as as deeply and and, and strongly as,
as I want to have the knowledge. So that's, I highly suggest that
anyone who wants to better themselves as a medic, well,
first do the deed. But then, yeah, talk to me or
talk to Eric about the microscopy course.
Yeah, because just just learning how to use the microscope is is
it's not depending on the microscope you have.
We in Malta, we use the the small ones, the portable ones.
But if you have access to the big ones, it's really nice to
know how to turn it on, how to adjust it and how to get the
best image of it and how to actually look at the slide.
How are you manoeuvring the slide in the microscope and
knowing where you're at and how to actually investigate the
things that you're looking at? In, in Malta, we have the Newton
microscope, which gets you about 900 X is made in, in Japan and
made in England. It's, it's OK and, and most
microscopists will refuse to acknowledge anything under 1000
X because that's when you go and, and use oil immersion.
But we use them in a classroom and you can't differentiate
malaria. And you can see, of course, the
helmets swimming around in the blood.
We train on those because that's what you're going to have in the
field. You're not going to bring a huge
desktop microscope into a jungle ICU.
So that is. And we use the smartphone ones
as well, but those only go up to 400 X watch.
So we've deviated a bit, Eric, from our concept of MC mech and
farm going into a passion of trop, trop Med, which does fall
under DNBII. Get it?
Yeah, I'm sorry for that. It's a passion.
It is definitely a passion. So I encourage you to see the
new APC, the Austria primary care module that we have up and
running on our website. Or you can purchase the Mick
Mack and farm individually and you still get some really good
learning. But if you want the full
package, the APC is now live and I look forward to hearing the
feedback from people going through it because in four or
five years we're going to read those and improve what we're
what we've just created. Absolutely.
And if there's any questions, just to reach out to the Quorum
website and and we will answer any of your questions.
Yeah, we look forward to seeing how you like the new programme
and we'll see you next week. Thank you.
This has been a presentation from the College of Remote and
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