Are You Prepared to be a Long Logistical Distance from Medical Support?

Andy Thompson talks with James Ross, Co-Founder and Director of Nomad Risk, who provide risk management strategies for organisations working in remote, austere, and extreme environments across the globe, including Media and TV Production companies.

What is the backstory of Nomad Risk?

My business partner, Trevor Smith, and I met in South Africa. I was working as a security consultant for a group of mining companies based out of Cape Town. They were operating all over southern Africa and they had business interests in the Middle East as well. Part of that job was with an anti-poaching organisation in Mozambique. I would go for a couple of months at a time, training the game scouts. I was going on patrols in remote areas and was touted as the medic but realised that my skills were not quite up to it, at that point! I decided to further my medical training in South Africa which has a really good reputation for prehospital care. Cape Town has a reputation for being the murder capital of the world, and they have quite progressive paramedic skills. Standard paramedic practice there would be probably equivalent to an Advanced paramedic back here in the UK in terms of the skills they can perform. It is a really good place to learn your trade.

Trevor came out of the Royal Marines and had worked in the anti-piracy space and then in the security sector here in the UK, but also had targeted the medical industry as a key facet to remote area work. So, we are both paramedics with UK military backgrounds and kindred spirits in that we like to get to remote environments – we both had previous experience working in remote, hostile locations and we enjoy working there.

We started Nomad Risk in 2018. Our aim is to serve anyone working in remote, austere, or extreme environments.

We define Remote areas as those with extended times or distances from logistical, medical or practical support. We define Austere as resource-poor environments. Extreme encompasses risks from either environmental issues or the type of activity being undertaken. Freediving with sharks, or working in the freezing Arctic tundra for example!

We are mainly serving the media industry. We found that they go to these environments a lot more regularly than other people, but we have served private clients and we serve other corporate groups too.

What is the origin of the company name?

I was in Kazakhstan looking after a TV crew, travelling on a bus bouncing down the road, talking with Trevor on the phone, discussing the possible name. We drove past a group of nomads. That was the lightbulb moment. We both liked it, and by the time I came back from that trip, Trevor had already registered it with Companies House.

What is the nature of your training?

Our training is broken down into two areas. A Travel Safety package, and a Medical package. We do a lot more medical training than anything else.

Regarding Travel Safety, it works best for us as a one-day, in-person training package where one of us will instruct a non-practical, awareness course. It works well for people who are relatively new to working in difficult environments. We do tailor it to remote and politically unstable environments, but it does work for anyone travelling anywhere. We have delivered training to relatively young, inexperienced travellers. That’s where it really comes across well, giving them a good understanding of the particular difficulties operating in these more challenging areas; especially the specifics of how travel can be more difficult when working with TV crews, and some of the things to be looking out for, which – we found, when we do go away with TV crews – actually get forgotten quite quickly.

It is quite easy to talk about, for example, giving a TV crew who are going to be working in a hot environment, a couple of days to acclimatise, especially if they are going to be running around with a camera kit. When it comes to the actual planning process, that then can quite quickly get forgotten about, and the financial constraints often mean days that were designated for acclimatisation get sidelined. So, just making sure that they are aware of those issues is important.

We really put a lot of our emphasis into the Medical Training. We do a range of courses, some accredited and some not. The accredited ones are First Aid at Work, which is an OFQUAL regulated course, and the Emergency First Aid at Work course. These are really good basic first aid courses.

There’s a one-day and a three-day first aid course which gives people the ability to render first aid. The one-day course is really tailored towards traumatic and lifesaving critical interventions. The three-day courses are slightly more in-depth, involving a few more medical emergencies. It is tailored towards people who are working in a more high-risk environment.

We also deliver FREC, the First Response Emergency Care suite of courses, which is another OFQUAL regulated suite. Whereas the first aid courses are additional courses to your main role, FREC is a professional level qualification, a suite of qualifications that leads up to Paramedic so you could get a job as a Medic as your main role. The entry level course is FREC3, and you can progress through to FREC6. If you are qualified at level 6, then you can register as a paramedic with the HCPC. It gives a nice continuation of training and development.

We found that is a successful and adaptable course. We do put a “remote area” spin in it. For example, we delivered that course last year to some security advisers, colleagues of ours, who worked for Secret Compass. A group of 12 needed to qualify. These were experienced safety advisers who travel frequently with TV crews to remote areas, and this is their standalone medical qualification, so it is their main medical skill. We incorporate things like expedition planning and preparedness, evacuation, medevac – even setting up a helicopter landing zone.

The last type of medical training we provide are our bespoke courses. They are non-accredited, although we do provide a certificate of completion with a list of topics covered, which they can provide to an employer or for insurance purposes. We tend to deliver these more to TV crews as awareness training. Often TV crews do not need accreditation, but they want a medical course, and they want it tailored to the environment they are going in. That is where we can give great value, because we are a small company and we do have extensive experience deployed with these productions ourselves. We understand the difficulties of working in these remote areas, especially with TV crews and the specific difficulties they encounter. We can make it quite tailored to the specific production, to the specific environment and to the specific task that they are going to. I think that that has gone down well with those we have worked with so far.

What is on the horizon for Nomad?

Our plan for the next year is to give ourselves a bigger online presence. It is partly born out of the COVID-19 situation. Developing a strong online presence and incorporating in some online training is going to be beneficial for us. We have started to develop some online medical training, but the problem that we have run into is that of external validation and how these online courses can be recognised, not just in terms of accreditation, but also by insurance companies: whether they will accept that it is a suitable qualification for what is ultimately a practical skill. There are challenges there, but I think that there is definitely scope for well-delivered online training.

Recently we delivered a course which we split down the middle. Most of it – the theory – was online. Delegates then came in for a two-day practical element and we got really good feedback from that. It does not totally mitigate the COVID risk, but it reduces the face to face portion as far as possible. We would like to push the online element more and see where we can take that.

There are many companies providing different levels of first aid and security courses. What is your differentiation?

We are a relatively small organisation. I think that that helps us. It gives us flexibility and it gives us a personality some larger companies may not have. We can generate a really close working relationship with the clients and a lot of work comes via word of mouth. We have not developed lots of business through the website or a social media presence. It has come from a job which has been well received and word of mouth goes around that way. I think that that comes from the fact that we are small, flexible, and we do have the personality: our clients enjoy working with us because, not only do we provide their training, but we’ll then deploy with them. We understand the difficulties working in remote environments because we do it regularly ourselves and we work closely with TV productions ourselves. So, even little tips and tricks like making sure that the cameraman is looked after much more than everyone else because he is the one who’s not drinking all day in a hot environment. Things like that allow us to really tailor the courses well to the clients that we are supporting, giving us that point of difference, compared to potentially just a stand alone first aid training provider.

How has your training delivery evolved as you have developed your company?

Again, I point to online training. Recently we combined online and in-person training for the first time. That is only going to become more important. I cannot see a situation in the close future, certainly within the next couple of months, where we will be able to deliver full courses in person, so online needs to be made really smart, really succinct and it needs to be a really well delivered product. There is a combination of in-person training online, so almost like a zoom conference, where you put everyone on a Zoom call, but also pre-recorded videos. In the Spring who are going to film scenarios that you can base medical learning on.

Another benefit COVID-19 has been relatively small class sizes, which has actually meant that the individual learners get a lot more tutor interaction and the biggest classes we normally have would be a 12 group, and last week was a 12 online and then two days, two instructors and six trainees. It is a really good ratio and a positive, going forward.

Has COVID-19 changed your business model?

There is a separate business model for the online training to the in-person training, certainly. In-person training is the best way to teach medicine. You cannot do a better job. The product is far better. Personality comes across. The way we teach is really interactive. They get really good feedback; they make it enjoyable. You cannot generate that online. You cannot have that rapport with the guys online. Let us not forget, medical training is hands on and always will be. You cannot become competent in packing a wound or putting on a tourniquet from simply from watching a video. Certainly, I would not want anyone who had only done an online course coming to me, and I’m sure you’d be the same! That does not mean there is not a place for medical training online, but I think the business model is different. I think the level of training is going to be slightly lower. Where it is attractive to us is the scalability and it’s going to be cheaper, but you can sell a lot more of it.

If we can deliver online learning, even in the form of quite short videos, that enables representation of our company and what we stand for and the professionalism can come across video very well.

Is there a halfway solution, for the moment?

Where online learning has its best value is actually not so much those initial first aid treatments (where, even watching someone open an airway is always best done physically to feel what it is like: how much force you need to apply, how deep you need to go on a chest compression). However, in expedition-type medicine, you are not often doing CPR. You are bandaging wounds. You are looking for a cause of infection and how unwell is this person? It is about decision making – do we need to evacuate this person, or can we manage them in a field? That comes across really well in an online course. You can talk about vital signs; you can talk about whether a person is becoming septic, for example: what sort of things do you need to look at in terms of understanding your decision-making paradigm based on how you are going to treat someone in the field, versus deciding to evacuate.

Given the fact that we really tailor our courses to those remote environments, that approach is actually much more relevant and likely. It is a much more realistic scenario for what people will be faced with. If you are doing CPR in a remote area, even the best CPR in the world is unlikely to have a really good result because you are going to have to extract the patient, whereas people do cut their legs in the jungle they do become infected. Then we have the pressure from the production company saying they want to carry on filming, and we have someone who is deteriorating. We need to know what those red flags are, what those warning signs are, and judge our decision on that.

We have a telemedicine service also. If a production does not want to take a Medic with them, they can use this service to have a discussion with a doctor or paramedic who is back in the UK. This will improve their decisions and increases the number of drugs they’re able to give in those environments as well, because to be able to carry things like antibiotics given on prescription of the doctor back in the UK.

Beyond COVID and technology evolutions, what challenges have you faced, day to day?

One of the challenges that we have faced so far certainly has been that we are a relatively new company in the market. It has been a challenge getting recognised and building a reputation. We are very good at what we do. The courses that we provide are really good and we have excellent medics with real experience. We have not had a problem, after having worked with someone, to get their business back again. What has been difficult for us is getting that initial business. Where we have been really supported, is in our relationships with similar companies. That is really important to us. One of the points that we think about in the way we go about our business to develop great working relationships with these companies. We work closely with companies like First Option, Secret Compass and Oscar Charlie, all of which are fantastic training and risk management providers. I think it is really important to have those good relationships, as there are frequently scenarios where we can be mutually supportive and deliver better products to clients.

Looking inwards to the client, we have had challenges with people, depending on their experiences. People who have done nothing before are usually very receptive to what you are telling them. The people who have done a lot before are very receptive to what you are telling them. It is the people who have done a little bit who tend to think they know everything. It can make getting across different points to some people who have been to genuine situations but have not got a huge amount of experience, more difficult. With medical training especially, though, everyone can benefit, and they recognize that. They usually do these courses before a potentially stressful deployment. That sharpens the mind for them. If they were just doing a medical course for the sake of it, they would not apply themselves. If there is a chance that where they are going means they might get a leg blown off, then they listen in!

What frustrates you about the broader training environment?

Certainly, we are not the cheapest company and there are companies that do play hard with margins, and offer cheaper alternatives, but I do not really have an issue with that. You get what you pay for. If there was a message to people who are looking to get some medical training, it is to look at experience. What is the skill set and what is the experience of the instructors who are going to be delivering that training and how can they demonstrate that what they are going to be delivering is actually based on experience and based on actual credentials?

To become a first aid trainer, you only need to have a first aid certificate and a training course certificate, which are quite quick things to get, so there is a huge variation in the type of people that can be delivering this training. That is not to say that those guys are not going to be good instructors, but if I were going to be selecting training for my guys and I was looking for the best training, it’s not necessarily the cheapest that is the best, the question should be “what is going to get you the most out of the experience?”. It is a relatively short course – a week or less – and you have got to look at it as an investment You want the best people to be giving the most amount of input.

Who has stood out for you as a training provider of particular impact and competence?  

Firstly, I found Frontier Risks and their SRMC course to be a really fantastic two weeks. Pete Lawrence and Duncan Godfrey who run it are great guys. The course has come in so handy for planning trips – not necessarily in terms of the training, but in a lot of the other work that we do regarding generalised risk management strategies that we provide. A lot of that has come off the back of what we learned in that course. I thought that was a really good, well-run, and professionally delivered course. I would recommend them. They pull everything together as a risk management package really well, which helped us enormously. They operate a good alumnus too, where you stay in touch and learn from other people.

The second one of note is a company called Remote Ropes, and Waldo Etherington, working out of Bristol [South West England]. He delivers awesome training. A lot of the work we do is remote and “down and dirty”. He has an abundance of experience in this kind of environment. He is a rigger. He rigs a lot of high lines, tension lines, filming lines for the film industry. He does a series of courses called Remote Rigging, where you are creating the most from the minimum amount of kit. So obviously, a lot of this involves hiking kit into the jungle or wherever you are going to create this. You have got a small amount of kit, most amount of bang for your buck in terms of getting the most out of that kit. He is a very, very good instructor. Although not the same niche, it is not medical, he really sings off the same song sheet in terms of the remote, austere, and extreme environments. I would definitely recommend finding out about his course and signpost towards that for people who want to get into this industry as well.

Then, in terms of the medical piece, a company called Vesalius Medical, is a fantastic medical course. The director, Kevin Wheeler, is a paramedic, also ex-military (Royal Marines) and now works for search and rescue helicopters. In terms of his clinical skills, I would say he is probably second to none. His paramedic skills are a top level, and he is a dedicated trainer. Where he is different to us is that he is training people more specifically for work in the UK. So, gold standard UK based practise, whereas we have a more remote area spin to it, but certainly we are glad to have worked with him.

If you are looking for a purely online training, then Silk Road training is certainly leading the way with their virtual and augmented reality suite of courses. These guys are making hostile environment style training of the future a reality today. It is also great value for regions or sectors who cannot afford to spend a week at a residential course here in the UK.

James Ross can be contacted via email at james@nomadrisk.com or visit https://www.nomadrisk.com/

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