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 Avico Kelly. This week we're with William
Crippo who just graduated from our Masters of Auster Critical
Care programme. William, welcome to the podcast.
Thank you Abric for inviting me onto this amazing platform that
you have. Well, the beauty of it is I get
to invite people smarter than me to onto the podcast and I learn
every week. So tell us a bit about yourself
and what's keeping you busy. Well, I am currently a paramedic
in Northwest Montana. I am doing a lot of pre hospital
education, whether that's wilderness medicine, just
ambulance area ambulance education.
And then I do kind of get around and do some military and
tactical medicine contract work. That's generally where I find
myself these days. And if you were to look at my
schedule or it keeps me pretty busy, so.
You teach tactical medicine? What?
What's your background in that? I was in the military for four
years, seemingly a lifetime ago. I was in entry, I didn't do
anything medical. I was all and told to go to an
EMT course in in between a couple deployments I had and
between that and interaction with our embedded combat medics
kind of got me interested in medicine.
So following service, waiting for other things to happen, I
went to the fire Academy to do like structural firefighting and
then EMT and paramedic. And then from there I made it
onto a county SWAT team where I started getting more into that
kind of thing. And then that was about 2019.
So about since 2019 I've been off and on teaching TC-3 courses
and then started getting into some more TC-3 and prolonged
field care and soft medicine and that sort of thing.
So wait a minute, you, you did EMT in the army and then you got
out and you had to do EMT again? Yes.
Unfortunately the programme that we were in didn't allow us to go
take the national registry right away.
I think it was about four or five months after we had
finished the course and I was burnt out and overlooking at
textbooks and whatnot to review. So I didn't end up passing the
first time. So I ended up having to take it
again. Does.
That make it easier the second time?
Or were you pretty upset and angry that you had to redo it?
Oh, it was probably a good, good idea for me to go back and take
it over again. I don't think at that point in
time my mind wasn't in the right headspace.
I think to actually be effective with doing any sort of medicine,
especially at the EMT level. Obviously we were all trained in
that at that time was called CLS Combat Lightsaber.
I was the inventory. I was more of a knuckle dragger
trigger puller as you refer to. So I I think it was a good idea
that I had taken it again. I've found that the more times
that I teach a paramedic course and I get to sit in the back of
the classroom listening to my faculty teach, it makes me
better. And not to be honest.
I started all of this because I am not smart enough to get all
of the paramedic knowledge on the first course, having to
reattend and teach again and again.
Again. That's what 12 courses now I've
taught over the years and every time I I learned something new.
Absolutely. Every time that I assist with an
EMT class or a paramedic class or wilderness first responder
class, I'm always picking up little things, not even just
from the other instructors that I'm I'm with.
A lot of times it's a student's because everybody comes with
different backgrounds and education and even the amount of
knowledge that you can gather from somebody that doesn't
really have a medical education and just how they may think of
one thing versus another. I I always learn forever student
as we say. Fantastic.
So you mentioned woofer, the wilderness first responder.
And there's, there's something magical about teaching the
woofer. The you get people coming in the
door that don't want to be medical, but they're there
because they have to. And nine days later they exit
and some of them are on fire about medicine, some aren't, but
they still have enjoyed the nine days.
How do you find teaching the woofer?
I I absolutely love it. It's a amazing blend between
about, I would say, a little bit of EMT level type knowledge and
then blending it in with being in the wilderness and outdoors,
which is something that I enjoy, especially being here in
Montana. And it seems like more time than
not, people are always coming up to us after classes and asking
how they can pursue more medical education.
You know, where's the next step? What else can I do to be to take
this a little bit further and you know, be better at my job?
Because a lot of them are hiking guides, like backpacking guides,
river guides and those sort of things.
And definitely they usually start off the class because
their organisation sent them. And like you said, they may not
necessarily be excited about medicine, but more, like I said,
more, more times than not, they, you can kind of see that fire
start. So it's a, it's absolutely
amazing teaching that, that level of class.
It's, it's just long enough to where that that fire kind of
starts. And like I said, it's just, I
would say it's probably just in some levels, it's just shy of
the EMT education, but it gives you a little bit more time to go
a little bit more in depth. Whereas maybe shorter courses
find myself having to hold, hold back on some things because you
just, you just don't have the time to discuss and go into the
detail. So I definitely love teaching
those types of courses. And nine days is enough to to
deep dive in some of the fun topics.
Definitely and bringing up some of the improvised medicine that
I've learned from you and going through the austere critical
care programme, which I know we'll get into.
But I definitely for those shorter courses, I've, you know,
I don't feel like I get the time to dive into some of that stuff,
but because of the longer course we get to discuss some of those
things so. If I were to look back at the
history of the college and all the way back to remote medicine
Ireland and and in Ireland in County Kerry, we were running
the the Wolfer course. There was the first course of an
0 2008 we're running because I was teaching bushcraft and
start, of course, you got to throw medicine into us.
We did the, the wilderness first responder and it got really
popular in Ireland and getting more and more people.
And then they finished and they're like, what's next?
So well, fact now we got to create a, a remote EMT or as
wilderness EMT back then. And they finished that and they
said, well, what's next? What's next, What's next?
And so we had to create the industry paramedic programme,
which then turned into the remote paramedic programme and,
and, and here we are now we have a doctoral yet and you did the
master's programme and all of Quorum started with the passion
found by people taking the wilderness first responder.
Yes, it's, it's awesome. And I always refer people.
They want to learn more. There's plenty of organisations
here in the United States, but I always let them know that I've
got my degree, my higher education degrees from Quorum.
So I send them your way. Hopefully some of them have
taken me up on that. But I, I definitely think they
see kind of what the end product is.
And I've gotten a lot of amazing feedback on things that I
brought to the table. And a lot of it is techniques
and topics and other things that I've gotten from Quorum's
programmes. So so.
Sure. Let's, let's talk about Malta.
You've you've been a couple of times and just recently you
graduated at the Medicine and Mediterranean Conference in
January and we can talk about that.
But let's first talk about your first trip to Malta.
Tell us about that. Sure.
So my first trip to Malta was for the APIs and eye care
courses. So that was within I think the
first year or two years that I was with college.
Again, amazing programme, all hands on.
You do I think about 9599% of the learning and course material
online before you even show up. And then the entire time we were
there, you guys just bombarded us with scenario after scenario,
which is definitely, I feel like it's the best way to learn and
at least show you how to apply those things that you go over
online before. Definitely.
I always tell people stories for going through the I care just
about all of the scenarios that you guys had given and the
moolage and all of that that you've done for your patients is
absolutely fantastic. Definitely put a lot of a lot of
effort into that and it shows. And I think it only makes you a
better clinician because now you actually get to practise what
you had learned on, on people and things that look extremely
real, especially your, I don't know how much detail you want me
to get into, but your burn patients were top, top notch,
probably most realistic that I've seen outside of the outside
of the real world. So that is a difficult programme
to run and it's my favourite. I mean, I've designed it from
ground up to be very much hands on, but from the back end of it,
the three faculty and, and one logistician, we have to to run
it is, is tough and, and there's, there's 20 scenarios in
five days. And we found that, well, I
learned by hand knowledge sitting in a classroom, flying
all the way across the world, sitting in a classroom and
somebody going click on the PowerPoint makes me cross.
So we, we didn't have that. Well, the four PowerPoint slides
you have in the whole 5 days are 4 scenarios that I walk you
through every every morning. So you can kind of see the
quorum way. But we, yeah, we found that you
can't have your bum on a seat. You have to be open about and go
through these 16 live scenarios and the, and the four PowerPoint
based scenarios. And in the, in the middle of
that, that throw you things like my, my current research on wound
vac, improvised wound vac or other improvised options or some
of that, that, well, it is a critical care programme.
So we do have to throw some critical care skills in there.
But it, I would love to be able to take that as a student, not
knowing as I walk in what to expect because I only got to see
the back end. So it's great to hear your
feedback on this programme. Yeah.
And I can't speak enough about the in person or even, you know,
the online prep up to that, but I think it was a great balance
between feeling confident going in and then even first, second,
third, fourth day, however long the eye care was just walking
in, not knowing what you're going to get and then knowing
kind of how the previous day had went.
It's again, you walk into the course and it's like, OK, what
what is the, what is a brick have in store for us today?
So it kind of puts you on the edge of your seat.
And like I said, I think that makes you a better, a better
person on the on the back end because it's it's it directly
transfers to what you're going to be doing either in the
wilderness or on the helicopter or on the ambulance.
You never know what the next call is going to be.
So yeah, absolutely amazing. Before we jump and and do a deep
dive into the Masters of Austria Critical Care, let's have a chat
about your commencement and the Medicine in the Mediterranean
Conference that you attended in Malta.
How was that? It was great.
That was the first conference that I've been to with you guys
and I am a return. I will be returning for all the
ones to come if I can make it. Nice.
But absolutely amazing. I took the first workshop that
was with the guys from Ukraine talking about blood
resuscitation, the drone threats for BOA and all of that.
And I think that was kind of a nice catapult into the rest of
the conference. And then just all of the other
presentations that were happening throughout the
weekend, Arctic Medicine and the product demonstrations, they
were all absolutely amazing. I also got Take My WPC
wilderness Paramedic certification exam, good old
paper and pencil certification exam, but I ended up
successfully completing that. So that was kind of the the
cherry on top of graduating, going to an amazing conference
and talking with everybody who is in attendance.
And you got to have the commencement, So how many times
have you marched across the stage to earn a degree?
So that was my, well, I guess, I suppose if you count high
school, I guess that was my third time.
I do have a bachelor's that I had gotten in criminal justice
and International Studies prior to that.
So that would have been the next higher degree.
So that would have been third time, yes.
So when are you going to do your doctorate?
I am currently actually going back through my thesis after
speaking with Doctor Chava and Ella at the conference.
I was talked into possibly publishing some of the research
that I had done on my thesis and then at some point, which I know
you guys are putting together a PhD programme if I'm not
mistaken. We have the DHS as a doctorate,
but yes, we have submitted a PhD programme focusing on
publication. Perfect.
So at some point, yes, I will be moving forward with that.
I think the first step is getting some of my thesis
published, but that is in the near to middle near future.
Good, good. So let's deep dive, Let's talk
about the Masters of Austere critical care.
So Willa, my first question for you is why?
Why did you come to Malta? Why did you choose our Masters
of Austere Critical? Care.
Honestly, it started I was out on contract doing some executive
protection and then also as a paramedic and I was just looking
for something extra to kind of put behind me education wise.
So honestly, I don't I'm trying to remember how I came across
Quorum, but once I found it, it was extremely easy for me to
make a decision whether or not I was going to jump into the
programme. I was in a location where I did
have some time off. So starting the online portion
actually gave me something else to look forward to when I was
getting off of shift or off of mission.
And just looking through everything leading up to the
first day of class, I suppose got it, got me excited.
It reinvigorated me into medicine.
I suppose. I'd been a paramedic for about
four or five years at that point and think I was kind of hitting
that stall period where you are probably overconfident in your
abilities and maybe you get a little bored with what you're
doing from day-to-day. So again, after finding the
austere critical care programme kind of reinvigorated my
interest in medicine and beyond. There are tonnes of masters
programmes out there and quite a few in critical care, so why did
you choose ours? Well, like I said, just
researching quorum in the background, people like yourself
and all the other instructors and box that you guys employ.
Part of what's amazing or a huge part of what's amazing about the
ACC programme is just that ever. There's people that come from
all over the world, all walks of life, doctors, paramedics, EMTs,
nurses, and they all bring something different to the
table. They don't, we don't do things
the same as somebody may do in in the middle of Africa or even
in Europe or Australia or New Zealand, a lot of those places.
So I feel like that's what sets Quorum from aside from everybody
else. In one of the talking points
that I have when people get interested in Quorum and what
you guys do, it's honestly it's second, second to none.
Just having that experience that you bring to the table with all
of your educational persons. Yeah, you can't get that
anywhere else. So while there's other critical
care programmes and degrees places that's, I don't think
anybody's come close to that. I could be wrong, but at least
from what I've looked into in my research I I think that sets you
guys above well above everybody else.
So as a 2018, I looked around to see what options are out there
for my master's degree. So we had the bachelor's and and
then of course the next step is is master's and there is a pre
hospital critical care programme in Norway for paramedics.
But their whole concept is all right, you're treating this guy
and 20 minutes you're in the hospital.
OK, now you're done. And that's not what we were
looking for. We we knew we had to design it
from scratch. Thankfully we had some really
smart people that Doctor Chubb has an MDPHD hems.
He was started, he started out his career as a freshly
graduated doc on the ambulances in Hungary.
So he has tonnes of EMS experience.
He's a doc that gets it. He understands the pre hospital
mentality. It's is brilliant.
So he helped design this programme.
I kind of put everything into place and he stepped in and made
it much better than I could. So he's the one that wrote the
back end the online. So tell, tell the listener what
was, is it like what, what was the programme like for the
essays? So the back end the
communication with our MDPHD mentors.
And I guess that's one of the other things that I definitely
wanted to mention. So communication between any of
the instructors was super helpful.
Amazing some of the insights that they had in how things
would work out in the out in the fields, being practical, which
is something that I feel like I do pretty well at when I teach,
when I go out and teach, whatever it is.
So taking the concepts online that you learn or in a book and
basically breaking it down and showing you, but this is how
it's actually going to look like in the field.
So right, going through doing all of the assignments and
essays, they're all very what's the that I'm looking for.
It was they were all very practical.
So whether you were doing essays on Ebola, you know, things that
are actually going on in the world and basically how would
you deal with this or that? And then other critical care
concepts. It was all things that you can
that I could then leave class or lecture that day and go apply in
my own practise, depending on what the critical care topic
was. But it was also very nice that
again, with Doctor Chava and, and everybody else, even if they
were, you know, a doctor or an advanced practise person, we're
all learning. So it was also kind of nice
because I guess depending on where you work, you know, maybe
doctors could be held on a, a pedestal, if you will, and maybe
they're not the easiest people to approach.
But it, it kind of brought you, brought you back around to where
we're all clinicians, we're all in this together.
We're all here to help the patients.
And they showed that, you know, if they can, you can chat with
them just like you would with a fellow EMT or paramedic, you
know, at my level. And it wasn't anything to be
afraid of, I suppose. And just the, the back and forth
exchange of information was, was amazing.
No matter what the topic was, they were always open to hearing
feedback discussions because they knew just as well as we did
that. May be different in whatever
area of the world that you or I operate in.
And they were always open to hear how these things, these
topics, actually apply in your realm.
Yeah, we needed the MD PhD D's to pick this up and run.
And this it's not something that me as a critical paramedic could
have spearheaded. Just having trouble and having
Ella doctor Sean Bilodeau, who's a EMS doc in Maine.
These these docs that have done it, they've they've worked in
the front lines pre hospital and are the ones that now that are
leading you through the discovery process of creating
your thesis. So what was your thesis topic?
So my thesis had to do with mechanical ventilation in low
resources, austere environments. So basically was focusing on how
to provide automatic or automated ventilation, how to
extend the life of your oxygen source and your ventilator in
that type of environment. It was all something that as far
as mechanical ventilation goes, being a critical care and flight
paramedic, the paramedics always the, at least in the few
organisations that I, I was in, you were the airway and then the
vent guy and the nurse was the medications person.
So I had an interest in mechanical ventilation for a
little while at that point. And then as far as where the
topic came from, there were a few articles that I came across
in the JSOM journal and that kind of launched me into looking
into and coming up with that thesis.
So let's. Say that you have a presentation
and you have 15 seconds to describe the best or one of the
main learning outcomes of your master's thesis.
What would that been? That basically we can provide
austere mechanical ventilation utilising something as simple as
an oxygen portable oxygen concentrator by simply injecting
A rebreather, a closed circuit system that you would have in
like anaesthesia or diving. And can that get up to 12 litres
a minute? In some instances it can.
So definitely the the flow rate and how you how high you can get
your Fio 2 obviously does the depend on the respiratory rate
and the title volume of your patient.
But even with some of the research articles that I found
that this is not my concept. This was just something I became
interested in and they actually it has been tested just a couple
times and it hasn't been widely researched.
But even with a half litre or a litre per minute from a portable
oxygen concentrator, you can get anywhere from about .8 to .9 for
your FIO 2 for hours and hours. So as long as you can keep your
oxygen concentrator charged. Which is another problem and
another rabbit hole that I had to restrain myself from going
down during my recent search. It would just be your your CO2
scrubber medium, like your soda zorb or anything like that that
would need to be changed out. But even then, talking four or
five, six hours till you would need to do that.
Did you look at using 2 oxygen portable oxygen generators and
having AT shape or a Daisy chain?
Or is there any way that you could have two six litre
portable oxygen canisters make 12?
Yes. And actually there were a few
different articles that they had come across that they actually
did that, just without the closed circuit system.
So they wired 2 oxygen concentrators into a vent just
to see what Fio 2 they were able to achieve.
So yes, that is that is an option.
However, being the austere critical care programme, I was
trying to come up with things that were not super resource
dependent. I suppose if you are blessed to
have a couple different oxygen concentrators, then obviously we
you could achieve much higher FIO 2 for those extended
durations. I was trying to keep in the back
of my mind though that you'd probably be limited on equipment
and even if you had one concentrator you you would be
considered lucky. But yes, there there were a few
articles that I came across that did test that.
I don't believe any one of them did that with a closed circuit
system. But obviously as you bump up
your leader flow then your Sky's the limit, probably for FI O2
using one of those type circuits.
So looking at your experience through the Masters of Austria
Critical Care, what were some of the challenges you faced on this
programme? Well.
I know personally for me, time management and depending on what
I was doing and where I was in the world, it has always been a
challenge for me and I've never been, I suppose, a great
student. So I kind of had to reel myself
back in and make sure that I was getting assignments done on a
timely basis. But honestly, the programme made
it easy. It was kind of, you know, go at
your own pace. So in that case it made it easy.
It was more just when it came down to the thesis, I kind of
had to create my own timeline for things.
So that was a just a personal challenge, but some people are
better at that. But honestly, the rest of the
programme was great. I didn't really come across too
many challenges. Maybe one of the ones that I'd
come across that I think we had chatted about as you would do
kind of evals as the programme would go along was just because
we all come from different parts of the world.
Sometimes syncing up time and getting responses about this or
that. Again, just because of time
differences and schedules and whatnot.
Sometimes those were challenging, but the staff at
Coram and your mentors going to the programme really made it a
point to questions as best as possible and as quick as
possible. So I think that's kind of just
an intrinsic type of thing. That's when you bring in people
from all over the world so that are still practising, which I
think is key for having people a part of your programme doing the
education. You got to have people that are
still doing doing the thing. So I think it just it comes with
some of those challenges. How has this changed your
clinical practise? Well, definitely the immediate
change has been in any of the wilderness medicine education
that's kind of a direct corollary to that.
And then when I'm out doing your military and tactical medicine
and injecting some of the prolonged field care lessons and
whatnot, that's definitely a one to one type of thing that I can
take straight from the ACC programme into that.
And then just the way you generally think about pre
hospital medicine that can be applied anywhere from ambulance
to an air evacuation platform and even in hospital depending
on where you're at. I haven't worked in a hospital,
but definitely anywhere in Montana.
They we call it frontier medicine out here.
So a lot of this could be applicable even if you do have 4
walls and bright lights around you.
Nice. Well, yeah, let me let me ask
you this. So somebody waves a magic wand
and you and I change seat. So now I get to live in rural,
rugged Montana, right on the border of Canada, being a remote
paramedic, and you're stuck in the office as Dean emeritus of
Coram. How would you change the looking
at the Masters of Austria Critical care?
What would what would you want to improve and what would you
put into the programme? Well, I definitely like the the
way that you guys are moving forward.
You've added a whole bunch more courses, elective type courses
to the programme that I had heard about in one of your other
podcasts. I'm so kind of jealous that I
haven't been able to, I haven't had the opportunity to take
those, but I'm not sure I really enjoyed kind of the way it is
and how everything's laid out with the eye care and your APIs
courses and all the other things that are offered that students
are able to take during the programme.
I, I think you guys got a good thing going.
I don't, I don't necessarily know if I would change much.
I will say if you, if we swap seats, you better bring your
work gloves and Carharts out here because you're going to
you're going to work and definitely working in an office
is is not for me. I just came back from being away
for about 3 weeks teaching various wilderness medicine and
EMT courses and sitting in my at Home Office and I don't care for
it. I'd rather I'd rather be out
doing the thing, teaching the thing.
You are teaching woofer with Doc Pearson.
Yes, yes. Yeah.
So tell us how that was that in Taos or was that in Utah?
So that was in Utah, it was a couple hours east of Salt Lake
City where we were. So that was 1 woofer that I was
teaching and he, he's putting together an amazing programme.
Black Swan is the name of his organisation, but he had a
couple other docs there and then between me and a couple other
people that were from the flight in pre hospital realm helping
out teach the course. It was an amazing programme.
That was my first kind of foray into teaching a wilderness
medicine class and then since then I've done a couple other
with a few different programmes. Everybody has their own flavour
on how they do things, but taking a lot of those lessons
from the ACC or just Quorum programmes that I've been
through, they definitely were happy and excited when I would
bring some of those things in a lot.
A lot of those are simple, you know, not resource intensive, so
obviously they were a welcome addition to a wilderness type
course. So, William, what's next for
you? What's next?
Well, I just received my, I guess just got my foam approval.
That'll go well done. Thank you that is that is not
easy mate. No.
And it but it was another one of those things that I started
actually at the eye care. You guys had brought it up.
I didn't know much about the Wilderness Medical Society and I
knew nothing about the foam programme and it was brought up
on one of the days for the eye care.
So I signed up, got that started, which was a huge, it
took a huge chunk out of the required credits.
So I'm glad that I did that. But yes, it's been a long time,
what, 3 1/2 years or so of work. So I finally got that.
So I always joke it's, you know, more letters to put after your
name and in some instances you kind of you need that just so
that people maybe take you more more seriously.
No, it was an amazing programme. Definitely glad that I was able
to complete that. And they have plenty of other
opportunities to continue and go past the farm.
So planning on doing that. As far as moving forward, I
going to continue doing wilderness medicine and
education. So the woofer, the building, his
first aid classes, I have some TC-3 and other classes, contract
classes coming up here. And then my quote unquote day
job is managing pre hospital education for a company in in
Kalispell in the Flathead Valley area.
So that'll keep me busy for a little bit.
You know, to be fair, the form credential is, I hold it in high
regard, so if I'm looking at what someone published or if I
have, we get applications all the time for teaching and when I
see the form it means something. It's not something you just buy.
There's so many crappy fellowships out there that
here's a few £100. Oh great, I've got an F after my
name and, and I mean there's a lot that aren't by any means,
but you have to work for the farm.
And that's one reason why I have jumped through the hoops for
what, 15-17 years now working with WMS, making sure that our
programmes are credited for farm, because I believe that
having your fellowship with WMS makes you a better well-rounded
clinician in the wilderness. Absolutely.
Yeah, I couldn't agree anymore. And all of the things that you
can get approved for credit wise.
And then they have a teaching component, which was actually
kind of why I went out to Utah to do the woofer class because
they were offering FOM teaching credit.
Nice. There's just so many things that
they allow you to do and ask of you to get that form.
It's definitely, it's definitely a process, something you have to
keep up with because they do have a time limit.
But yes, I do I agree. It's more than just paying to
have some letters come after your name.
You have to put a lot more work into it than that.
I agree. It's one of those things that
when you're looking at somebody in the wilderness medicine realm
and they have that, it's like, oh, OK.
And even more so if you're, if you're not a doc, I would say a
lot of things for the WMS are sometimes more geared towards
your doctors. But definitely if you have foam
and you know you're not, you're not a doc, just all of that
extra stuff that's required of you, I feel like definitely
holds you hold you in a little bit higher, higher regard.
I feel like in pre hospital medicine for sure.
It's been quite the journey going through that.
Indeed. So William, my final question
for you is this. What advice do you have for the
new medic, the new nurse, the new Doctor who is just starting
out in their career in austere medicine?
I would say just continue to learn.
Listen, listen to everybody who may be speaking in front of you.
Also reach out and try to find those people that are doing that
thing. This is a passion of yours being
in the wilderness and you're somebody that comes from the
medical field or vice versa. Just keep seeking out
information. Keep going to classes.
It's quite, quite the realm that you're getting into.
And just because we learn how to do X thing in an ambulance or in
a hospital, it doesn't always work out that way out in the
wilderness. So I just feel like again, being
being a forever student and you can always learn from anybody
who's around you, no matter student or educator.
That's good advice and it has been great to have you on the
podcast, William. And and it was fantastic to
shake your hand last January as you walked across the stage and
earned a Masters of Austere critical.
Care it was amazing to do that and I appreciate everything that
you've done for me in the college abric.
So thank you very much again for inviting me on to this platform
that you have. This has been a presentation
from the College of Remote and Offshore Medicine.
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