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Hello everyone and welcome to 
the Quorum podcast. 

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This is where academic medicine 
meets remote, austere and 

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resource limited areas. 
Welcome back to the podcast, 

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This is Avico Kelly. 
This week we're with William 

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Crippo who just graduated from 
our Masters of Auster Critical 

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Care programme. 
William, welcome to the podcast.

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Thank you Abric for inviting me 
onto this amazing platform that 

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you have. 
Well, the beauty of it is I get 

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to invite people smarter than me
to onto the podcast and I learn 

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every week. 
So tell us a bit about yourself 

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and what's keeping you busy. 
Well, I am currently a paramedic

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in Northwest Montana. 
I am doing a lot of pre hospital

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education, whether that's 
wilderness medicine, just 

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ambulance area ambulance 
education. 

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And then I do kind of get around
and do some military and 

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tactical medicine contract work.
That's generally where I find 

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myself these days. 
And if you were to look at my 

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schedule or it keeps me pretty 
busy, so. 

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You teach tactical medicine? 
What? 

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What's your background in that? 
I was in the military for four 

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years, seemingly a lifetime ago.
I was in entry, I didn't do 

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anything medical. 
I was all and told to go to an 

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EMT course in in between a 
couple deployments I had and 

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between that and interaction 
with our embedded combat medics 

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kind of got me interested in 
medicine. 

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So following service, waiting 
for other things to happen, I 

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went to the fire Academy to do 
like structural firefighting and

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then EMT and paramedic. 
And then from there I made it 

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onto a county SWAT team where I 
started getting more into that 

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kind of thing. 
And then that was about 2019. 

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So about since 2019 I've been 
off and on teaching TC-3 courses

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and then started getting into 
some more TC-3 and prolonged 

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field care and soft medicine and
that sort of thing. 

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So wait a minute, you, you did 
EMT in the army and then you got

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out and you had to do EMT again?
Yes. 

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Unfortunately the programme that
we were in didn't allow us to go

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take the national registry right
away. 

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I think it was about four or 
five months after we had 

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finished the course and I was 
burnt out and overlooking at 

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textbooks and whatnot to review.
So I didn't end up passing the 

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first time. 
So I ended up having to take it 

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again. 
Does. 

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That make it easier the second 
time? 

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Or were you pretty upset and 
angry that you had to redo it? 

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Oh, it was probably a good, good
idea for me to go back and take 

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it over again. 
I don't think at that point in 

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time my mind wasn't in the right
headspace. 

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I think to actually be effective
with doing any sort of medicine,

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especially at the EMT level. 
Obviously we were all trained in

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that at that time was called CLS
Combat Lightsaber. 

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I was the inventory. 
I was more of a knuckle dragger 

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trigger puller as you refer to. 
So I I think it was a good idea 

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that I had taken it again. 
I've found that the more times 

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that I teach a paramedic course 
and I get to sit in the back of 

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the classroom listening to my 
faculty teach, it makes me 

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better. 
And not to be honest. 

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I started all of this because I 
am not smart enough to get all 

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of the paramedic knowledge on 
the first course, having to 

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reattend and teach again and 
again. 

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Again. 
That's what 12 courses now I've 

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taught over the years and every 
time I I learned something new. 

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Absolutely. 
Every time that I assist with an

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EMT class or a paramedic class 
or wilderness first responder 

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class, I'm always picking up 
little things, not even just 

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from the other instructors that 
I'm I'm with. 

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A lot of times it's a student's 
because everybody comes with 

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different backgrounds and 
education and even the amount of

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knowledge that you can gather 
from somebody that doesn't 

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really have a medical education 
and just how they may think of 

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one thing versus another. 
I I always learn forever student

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as we say. 
Fantastic. 

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So you mentioned woofer, the 
wilderness first responder. 

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And there's, there's something 
magical about teaching the 

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woofer. 
The you get people coming in the

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door that don't want to be 
medical, but they're there 

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because they have to. 
And nine days later they exit 

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and some of them are on fire 
about medicine, some aren't, but

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they still have enjoyed the nine
days. 

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How do you find teaching the 
woofer? 

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I I absolutely love it. 
It's a amazing blend between 

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about, I would say, a little bit
of EMT level type knowledge and 

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then blending it in with being 
in the wilderness and outdoors, 

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which is something that I enjoy,
especially being here in 

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Montana. 
And it seems like more time than

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not, people are always coming up
to us after classes and asking 

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how they can pursue more medical
education. 

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You know, where's the next step?
What else can I do to be to take

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this a little bit further and 
you know, be better at my job? 

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Because a lot of them are hiking
guides, like backpacking guides,

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river guides and those sort of 
things. 

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And definitely they usually 
start off the class because 

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their organisation sent them. 
And like you said, they may not 

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necessarily be excited about 
medicine, but more, like I said,

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more, more times than not, they,
you can kind of see that fire 

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start. 
So it's a, it's absolutely 

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amazing teaching that, that 
level of class. 

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It's, it's just long enough to 
where that that fire kind of 

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starts. 
And like I said, it's just, I 

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would say it's probably just in 
some levels, it's just shy of 

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the EMT education, but it gives 
you a little bit more time to go

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a little bit more in depth. 
Whereas maybe shorter courses 

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find myself having to hold, hold
back on some things because you 

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just, you just don't have the 
time to discuss and go into the 

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detail. 
So I definitely love teaching 

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those types of courses. 
And nine days is enough to to 

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deep dive in some of the fun 
topics. 

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Definitely and bringing up some 
of the improvised medicine that 

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I've learned from you and going 
through the austere critical 

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care programme, which I know 
we'll get into. 

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But I definitely for those 
shorter courses, I've, you know,

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I don't feel like I get the time
to dive into some of that stuff,

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but because of the longer course
we get to discuss some of those 

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things so. 
If I were to look back at the 

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history of the college and all 
the way back to remote medicine 

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Ireland and and in Ireland in 
County Kerry, we were running 

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the the Wolfer course. 
There was the first course of an

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0 2008 we're running because I 
was teaching bushcraft and 

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start, of course, you got to 
throw medicine into us. 

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We did the, the wilderness first
responder and it got really 

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popular in Ireland and getting 
more and more people. 

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And then they finished and 
they're like, what's next? 

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So well, fact now we got to 
create a, a remote EMT or as 

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wilderness EMT back then. 
And they finished that and they 

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said, well, what's next? 
What's next, What's next? 

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And so we had to create the 
industry paramedic programme, 

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which then turned into the 
remote paramedic programme and, 

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and, and here we are now we have
a doctoral yet and you did the 

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master's programme and all of 
Quorum started with the passion 

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found by people taking the 
wilderness first responder. 

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Yes, it's, it's awesome. 
And I always refer people. 

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They want to learn more. 
There's plenty of organisations 

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here in the United States, but I
always let them know that I've 

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got my degree, my higher 
education degrees from Quorum. 

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So I send them your way. 
Hopefully some of them have 

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taken me up on that. 
But I, I definitely think they 

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see kind of what the end product
is. 

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And I've gotten a lot of amazing
feedback on things that I 

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brought to the table. 
And a lot of it is techniques 

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and topics and other things that
I've gotten from Quorum's 

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programmes. 
So so. 

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Sure. 
Let's, let's talk about Malta. 

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You've you've been a couple of 
times and just recently you 

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graduated at the Medicine and 
Mediterranean Conference in 

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January and we can talk about 
that. 

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But let's first talk about your 
first trip to Malta. 

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Tell us about that. 
Sure. 

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So my first trip to Malta was 
for the APIs and eye care 

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courses. 
So that was within I think the 

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first year or two years that I 
was with college. 

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Again, amazing programme, all 
hands on. 

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You do I think about 9599% of 
the learning and course material

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online before you even show up. 
And then the entire time we were

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there, you guys just bombarded 
us with scenario after scenario,

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which is definitely, I feel like
it's the best way to learn and 

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at least show you how to apply 
those things that you go over 

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online before. 
Definitely. 

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I always tell people stories for
going through the I care just 

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about all of the scenarios that 
you guys had given and the 

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moolage and all of that that 
you've done for your patients is

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absolutely fantastic. 
Definitely put a lot of a lot of

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effort into that and it shows. 
And I think it only makes you a 

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better clinician because now you
actually get to practise what 

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you had learned on, on people 
and things that look extremely 

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real, especially your, I don't 
know how much detail you want me

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to get into, but your burn 
patients were top, top notch, 

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probably most realistic that 
I've seen outside of the outside

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of the real world. 
So that is a difficult programme

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to run and it's my favourite. 
I mean, I've designed it from 

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ground up to be very much hands 
on, but from the back end of it,

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the three faculty and, and one 
logistician, we have to to run 

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it is, is tough and, and 
there's, there's 20 scenarios in

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five days. 
And we found that, well, I 

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learned by hand knowledge 
sitting in a classroom, flying 

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all the way across the world, 
sitting in a classroom and 

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somebody going click on the 
PowerPoint makes me cross. 

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So we, we didn't have that. 
Well, the four PowerPoint slides

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you have in the whole 5 days are
4 scenarios that I walk you 

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through every every morning. 
So you can kind of see the 

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quorum way. 
But we, yeah, we found that you 

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can't have your bum on a seat. 
You have to be open about and go

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through these 16 live scenarios 
and the, and the four PowerPoint

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based scenarios. 
And in the, in the middle of 

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that, that throw you things like
my, my current research on wound

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vac, improvised wound vac or 
other improvised options or some

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of that, that, well, it is a 
critical care programme. 

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So we do have to throw some 
critical care skills in there. 

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But it, I would love to be able 
to take that as a student, not 

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knowing as I walk in what to 
expect because I only got to see

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the back end. 
So it's great to hear your 

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feedback on this programme. 
Yeah. 

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And I can't speak enough about 
the in person or even, you know,

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the online prep up to that, but 
I think it was a great balance 

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between feeling confident going 
in and then even first, second, 

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third, fourth day, however long 
the eye care was just walking 

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in, not knowing what you're 
going to get and then knowing 

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kind of how the previous day had
went. 

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It's again, you walk into the 
course and it's like, OK, what 

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what is the, what is a brick 
have in store for us today? 

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So it kind of puts you on the 
edge of your seat. 

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And like I said, I think that 
makes you a better, a better 

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person on the on the back end 
because it's it's it directly 

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transfers to what you're going 
to be doing either in the 

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wilderness or on the helicopter 
or on the ambulance. 

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You never know what the next 
call is going to be. 

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So yeah, absolutely amazing. 
Before we jump and and do a deep

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dive into the Masters of Austria
Critical Care, let's have a chat

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about your commencement and the 
Medicine in the Mediterranean 

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Conference that you attended in 
Malta. 

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How was that? 
It was great. 

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That was the first conference 
that I've been to with you guys 

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and I am a return. 
I will be returning for all the 

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ones to come if I can make it. 
Nice. 

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But absolutely amazing. 
I took the first workshop that 

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was with the guys from Ukraine 
talking about blood 

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resuscitation, the drone threats
for BOA and all of that. 

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And I think that was kind of a 
nice catapult into the rest of 

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the conference. 
And then just all of the other 

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presentations that were 
happening throughout the 

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weekend, Arctic Medicine and the
product demonstrations, they 

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were all absolutely amazing. 
I also got Take My WPC 

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wilderness Paramedic 
certification exam, good old 

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paper and pencil certification 
exam, but I ended up 

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successfully completing that. 
So that was kind of the the 

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cherry on top of graduating, 
going to an amazing conference 

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and talking with everybody who 
is in attendance. 

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00:12:43,600 --> 00:12:45,960
And you got to have the 
commencement, So how many times 

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00:12:45,960 --> 00:12:48,640
have you marched across the 
stage to earn a degree? 

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00:12:49,000 --> 00:12:52,920
So that was my, well, I guess, I
suppose if you count high 

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00:12:52,920 --> 00:12:54,680
school, I guess that was my 
third time. 

230
00:12:55,080 --> 00:13:00,280
I do have a bachelor's that I 
had gotten in criminal justice 

231
00:13:00,280 --> 00:13:04,400
and International Studies prior 
to that. 

232
00:13:04,400 --> 00:13:08,800
So that would have been the next
higher degree. 

233
00:13:08,800 --> 00:13:10,760
So that would have been third 
time, yes. 

234
00:13:10,800 --> 00:13:13,160
So when are you going to do your
doctorate? 

235
00:13:13,560 --> 00:13:18,720
I am currently actually going 
back through my thesis after 

236
00:13:18,720 --> 00:13:23,520
speaking with Doctor Chava and 
Ella at the conference. 

237
00:13:23,520 --> 00:13:28,080
I was talked into possibly 
publishing some of the research 

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00:13:28,080 --> 00:13:32,280
that I had done on my thesis and
then at some point, which I know

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00:13:32,280 --> 00:13:35,600
you guys are putting together a 
PhD programme if I'm not 

240
00:13:35,600 --> 00:13:38,360
mistaken. 
We have the DHS as a doctorate, 

241
00:13:38,360 --> 00:13:42,440
but yes, we have submitted a PhD
programme focusing on 

242
00:13:42,440 --> 00:13:43,720
publication. 
Perfect. 

243
00:13:43,720 --> 00:13:49,080
So at some point, yes, I will be
moving forward with that. 

244
00:13:49,240 --> 00:13:53,640
I think the first step is 
getting some of my thesis 

245
00:13:53,640 --> 00:14:00,560
published, but that is in the 
near to middle near future. 

246
00:14:00,560 --> 00:14:03,880
Good, good. 
So let's deep dive, Let's talk 

247
00:14:03,880 --> 00:14:06,240
about the Masters of Austere 
critical care. 

248
00:14:06,400 --> 00:14:09,680
So Willa, my first question for 
you is why? 

249
00:14:09,760 --> 00:14:13,680
Why did you come to Malta? 
Why did you choose our Masters 

250
00:14:13,680 --> 00:14:15,080
of Austere Critical? 
Care. 

251
00:14:15,240 --> 00:14:19,800
Honestly, it started I was out 
on contract doing some executive

252
00:14:19,800 --> 00:14:23,120
protection and then also as a 
paramedic and I was just looking

253
00:14:23,120 --> 00:14:28,280
for something extra to kind of 
put behind me education wise. 

254
00:14:28,280 --> 00:14:31,680
So honestly, I don't I'm trying 
to remember how I came across 

255
00:14:31,680 --> 00:14:35,720
Quorum, but once I found it, it 
was extremely easy for me to 

256
00:14:35,720 --> 00:14:38,040
make a decision whether or not I
was going to jump into the 

257
00:14:38,040 --> 00:14:40,800
programme. 
I was in a location where I did 

258
00:14:40,800 --> 00:14:44,840
have some time off. 
So starting the online portion 

259
00:14:44,840 --> 00:14:47,920
actually gave me something else 
to look forward to when I was 

260
00:14:48,040 --> 00:14:50,040
getting off of shift or off of 
mission. 

261
00:14:50,080 --> 00:14:53,200
And just looking through 
everything leading up to the 

262
00:14:53,400 --> 00:14:57,000
first day of class, I suppose 
got it, got me excited. 

263
00:14:57,120 --> 00:14:59,800
It reinvigorated me into 
medicine. 

264
00:14:59,800 --> 00:15:02,040
I suppose. 
I'd been a paramedic for about 

265
00:15:02,040 --> 00:15:07,480
four or five years at that point
and think I was kind of hitting 

266
00:15:07,480 --> 00:15:12,720
that stall period where you are 
probably overconfident in your 

267
00:15:12,720 --> 00:15:15,800
abilities and maybe you get a 
little bored with what you're 

268
00:15:15,800 --> 00:15:18,920
doing from day-to-day. 
So again, after finding the 

269
00:15:19,080 --> 00:15:22,720
austere critical care programme 
kind of reinvigorated my 

270
00:15:22,920 --> 00:15:27,040
interest in medicine and beyond.
There are tonnes of masters 

271
00:15:27,040 --> 00:15:30,520
programmes out there and quite a
few in critical care, so why did

272
00:15:30,520 --> 00:15:32,840
you choose ours? 
Well, like I said, just 

273
00:15:32,840 --> 00:15:37,560
researching quorum in the 
background, people like yourself

274
00:15:37,560 --> 00:15:41,440
and all the other instructors 
and box that you guys employ. 

275
00:15:41,480 --> 00:15:45,520
Part of what's amazing or a huge
part of what's amazing about the

276
00:15:45,800 --> 00:15:50,040
ACC programme is just that ever.
There's people that come from 

277
00:15:50,040 --> 00:15:53,960
all over the world, all walks of
life, doctors, paramedics, EMTs,

278
00:15:53,960 --> 00:15:56,800
nurses, and they all bring 
something different to the 

279
00:15:56,800 --> 00:15:58,880
table. 
They don't, we don't do things 

280
00:15:58,880 --> 00:16:03,240
the same as somebody may do in 
in the middle of Africa or even 

281
00:16:03,240 --> 00:16:06,720
in Europe or Australia or New 
Zealand, a lot of those places. 

282
00:16:06,760 --> 00:16:11,440
So I feel like that's what sets 
Quorum from aside from everybody

283
00:16:11,440 --> 00:16:13,640
else. 
In one of the talking points 

284
00:16:13,640 --> 00:16:17,000
that I have when people get 
interested in Quorum and what 

285
00:16:17,000 --> 00:16:20,440
you guys do, it's honestly it's 
second, second to none. 

286
00:16:20,440 --> 00:16:25,200
Just having that experience that
you bring to the table with all 

287
00:16:25,200 --> 00:16:28,200
of your educational persons. 
Yeah, you can't get that 

288
00:16:28,200 --> 00:16:30,720
anywhere else. 
So while there's other critical 

289
00:16:30,720 --> 00:16:34,960
care programmes and degrees 
places that's, I don't think 

290
00:16:34,960 --> 00:16:37,960
anybody's come close to that. 
I could be wrong, but at least 

291
00:16:37,960 --> 00:16:41,720
from what I've looked into in my
research I I think that sets you

292
00:16:41,720 --> 00:16:44,080
guys above well above everybody 
else. 

293
00:16:44,960 --> 00:16:50,560
So as a 2018, I looked around to
see what options are out there 

294
00:16:50,560 --> 00:16:53,720
for my master's degree. 
So we had the bachelor's and and

295
00:16:53,720 --> 00:16:58,680
then of course the next step is 
is master's and there is a pre 

296
00:16:58,680 --> 00:17:02,040
hospital critical care programme
in Norway for paramedics. 

297
00:17:02,560 --> 00:17:07,200
But their whole concept is all 
right, you're treating this guy 

298
00:17:07,319 --> 00:17:08,640
and 20 minutes you're in the 
hospital. 

299
00:17:08,640 --> 00:17:11,079
OK, now you're done. 
And that's not what we were 

300
00:17:11,079 --> 00:17:14,480
looking for. 
We we knew we had to design it 

301
00:17:14,480 --> 00:17:17,800
from scratch. 
Thankfully we had some really 

302
00:17:17,800 --> 00:17:21,160
smart people that Doctor Chubb 
has an MDPHD hems. 

303
00:17:21,160 --> 00:17:24,839
He was started, he started out 
his career as a freshly 

304
00:17:24,839 --> 00:17:27,520
graduated doc on the ambulances 
in Hungary. 

305
00:17:27,520 --> 00:17:30,080
So he has tonnes of EMS 
experience. 

306
00:17:30,080 --> 00:17:33,920
He's a doc that gets it. 
He understands the pre hospital 

307
00:17:33,920 --> 00:17:35,440
mentality. 
It's is brilliant. 

308
00:17:35,440 --> 00:17:38,440
So he helped design this 
programme. 

309
00:17:38,440 --> 00:17:41,960
I kind of put everything into 
place and he stepped in and made

310
00:17:41,960 --> 00:17:45,480
it much better than I could. 
So he's the one that wrote the 

311
00:17:45,480 --> 00:17:48,800
back end the online. 
So tell, tell the listener what 

312
00:17:48,800 --> 00:17:52,200
was, is it like what, what was 
the programme like for the 

313
00:17:52,200 --> 00:17:53,840
essays? 
So the back end the 

314
00:17:53,840 --> 00:17:56,640
communication with our MDPHD 
mentors. 

315
00:17:56,920 --> 00:18:00,040
And I guess that's one of the 
other things that I definitely 

316
00:18:00,040 --> 00:18:03,320
wanted to mention. 
So communication between any of 

317
00:18:03,320 --> 00:18:06,000
the instructors was super 
helpful. 

318
00:18:06,000 --> 00:18:10,520
Amazing some of the insights 
that they had in how things 

319
00:18:10,680 --> 00:18:15,160
would work out in the out in the
fields, being practical, which 

320
00:18:15,160 --> 00:18:18,640
is something that I feel like I 
do pretty well at when I teach, 

321
00:18:18,640 --> 00:18:20,400
when I go out and teach, 
whatever it is. 

322
00:18:20,400 --> 00:18:24,720
So taking the concepts online 
that you learn or in a book and 

323
00:18:24,720 --> 00:18:28,440
basically breaking it down and 
showing you, but this is how 

324
00:18:28,440 --> 00:18:30,160
it's actually going to look like
in the field. 

325
00:18:30,160 --> 00:18:33,800
So right, going through doing 
all of the assignments and 

326
00:18:33,800 --> 00:18:37,400
essays, they're all very what's 
the that I'm looking for. 

327
00:18:37,440 --> 00:18:39,240
It was they were all very 
practical. 

328
00:18:39,240 --> 00:18:42,960
So whether you were doing essays
on Ebola, you know, things that 

329
00:18:42,960 --> 00:18:45,480
are actually going on in the 
world and basically how would 

330
00:18:45,480 --> 00:18:48,960
you deal with this or that? 
And then other critical care 

331
00:18:48,960 --> 00:18:52,240
concepts. 
It was all things that you can 

332
00:18:52,240 --> 00:18:56,960
that I could then leave class or
lecture that day and go apply in

333
00:18:56,960 --> 00:19:00,640
my own practise, depending on 
what the critical care topic 

334
00:19:00,640 --> 00:19:03,080
was. 
But it was also very nice that 

335
00:19:03,120 --> 00:19:07,160
again, with Doctor Chava and, 
and everybody else, even if they

336
00:19:07,160 --> 00:19:12,240
were, you know, a doctor or an 
advanced practise person, we're 

337
00:19:12,240 --> 00:19:15,280
all learning. 
So it was also kind of nice 

338
00:19:15,280 --> 00:19:19,880
because I guess depending on 
where you work, you know, maybe 

339
00:19:20,080 --> 00:19:24,360
doctors could be held on a, a 
pedestal, if you will, and maybe

340
00:19:24,360 --> 00:19:27,880
they're not the easiest people 
to approach. 

341
00:19:27,880 --> 00:19:33,120
But it, it kind of brought you, 
brought you back around to where

342
00:19:33,720 --> 00:19:35,600
we're all clinicians, we're all 
in this together. 

343
00:19:35,600 --> 00:19:37,960
We're all here to help the 
patients. 

344
00:19:37,960 --> 00:19:42,440
And they showed that, you know, 
if they can, you can chat with 

345
00:19:42,440 --> 00:19:46,440
them just like you would with a 
fellow EMT or paramedic, you 

346
00:19:46,440 --> 00:19:49,120
know, at my level. 
And it wasn't anything to be 

347
00:19:49,440 --> 00:19:52,720
afraid of, I suppose. 
And just the, the back and forth

348
00:19:53,000 --> 00:19:56,000
exchange of information was, was
amazing. 

349
00:19:56,000 --> 00:19:59,680
No matter what the topic was, 
they were always open to hearing

350
00:19:59,680 --> 00:20:03,120
feedback discussions because 
they knew just as well as we did

351
00:20:03,120 --> 00:20:05,280
that. 
May be different in whatever 

352
00:20:05,280 --> 00:20:08,480
area of the world that you or I 
operate in. 

353
00:20:08,480 --> 00:20:12,240
And they were always open to 
hear how these things, these 

354
00:20:12,240 --> 00:20:15,240
topics, actually apply in your 
realm. 

355
00:20:15,360 --> 00:20:20,280
Yeah, we needed the MD PhD D's 
to pick this up and run. 

356
00:20:20,280 --> 00:20:23,720
And this it's not something that
me as a critical paramedic could

357
00:20:23,720 --> 00:20:26,200
have spearheaded. 
Just having trouble and having 

358
00:20:26,200 --> 00:20:30,120
Ella doctor Sean Bilodeau, who's
a EMS doc in Maine. 

359
00:20:30,280 --> 00:20:33,520
These these docs that have done 
it, they've they've worked in 

360
00:20:33,520 --> 00:20:37,040
the front lines pre hospital and
are the ones that now that are 

361
00:20:37,160 --> 00:20:40,680
leading you through the 
discovery process of creating 

362
00:20:40,680 --> 00:20:44,280
your thesis. 
So what was your thesis topic? 

363
00:20:44,280 --> 00:20:48,800
So my thesis had to do with 
mechanical ventilation in low 

364
00:20:48,800 --> 00:20:53,200
resources, austere environments.
So basically was focusing on how

365
00:20:53,200 --> 00:20:57,040
to provide automatic or 
automated ventilation, how to 

366
00:20:57,040 --> 00:21:00,480
extend the life of your oxygen 
source and your ventilator in 

367
00:21:00,480 --> 00:21:03,720
that type of environment. 
It was all something that as far

368
00:21:03,720 --> 00:21:07,560
as mechanical ventilation goes, 
being a critical care and flight

369
00:21:07,560 --> 00:21:11,400
paramedic, the paramedics always
the, at least in the few 

370
00:21:11,480 --> 00:21:15,120
organisations that I, I was in, 
you were the airway and then the

371
00:21:15,120 --> 00:21:18,880
vent guy and the nurse was the 
medications person. 

372
00:21:18,920 --> 00:21:23,520
So I had an interest in 
mechanical ventilation for a 

373
00:21:23,520 --> 00:21:27,400
little while at that point. 
And then as far as where the 

374
00:21:27,400 --> 00:21:30,920
topic came from, there were a 
few articles that I came across 

375
00:21:30,920 --> 00:21:36,560
in the JSOM journal and that 
kind of launched me into looking

376
00:21:36,560 --> 00:21:38,440
into and coming up with that 
thesis. 

377
00:21:38,440 --> 00:21:41,600
So let's. 
Say that you have a presentation

378
00:21:41,680 --> 00:21:45,560
and you have 15 seconds to 
describe the best or one of the 

379
00:21:45,560 --> 00:21:48,920
main learning outcomes of your 
master's thesis. 

380
00:21:48,960 --> 00:21:52,880
What would that been? 
That basically we can provide 

381
00:21:52,880 --> 00:21:57,240
austere mechanical ventilation 
utilising something as simple as

382
00:21:57,240 --> 00:22:02,520
an oxygen portable oxygen 
concentrator by simply injecting

383
00:22:02,520 --> 00:22:06,400
A rebreather, a closed circuit 
system that you would have in 

384
00:22:06,400 --> 00:22:10,160
like anaesthesia or diving. 
And can that get up to 12 litres

385
00:22:10,200 --> 00:22:13,360
a minute? 
In some instances it can. 

386
00:22:13,360 --> 00:22:17,360
So definitely the the flow rate 
and how you how high you can get

387
00:22:17,360 --> 00:22:22,160
your Fio 2 obviously does the 
depend on the respiratory rate 

388
00:22:22,160 --> 00:22:24,560
and the title volume of your 
patient. 

389
00:22:24,640 --> 00:22:28,880
But even with some of the 
research articles that I found 

390
00:22:28,960 --> 00:22:32,040
that this is not my concept. 
This was just something I became

391
00:22:32,040 --> 00:22:36,440
interested in and they actually 
it has been tested just a couple

392
00:22:36,440 --> 00:22:39,520
times and it hasn't been widely 
researched. 

393
00:22:39,560 --> 00:22:43,960
But even with a half litre or a 
litre per minute from a portable

394
00:22:43,960 --> 00:22:50,960
oxygen concentrator, you can get
anywhere from about .8 to .9 for

395
00:22:50,960 --> 00:22:55,040
your FIO 2 for hours and hours. 
So as long as you can keep your 

396
00:22:55,040 --> 00:22:58,960
oxygen concentrator charged. 
Which is another problem and 

397
00:22:58,960 --> 00:23:02,440
another rabbit hole that I had 
to restrain myself from going 

398
00:23:02,440 --> 00:23:06,280
down during my recent search. 
It would just be your your CO2 

399
00:23:06,360 --> 00:23:10,040
scrubber medium, like your soda 
zorb or anything like that that 

400
00:23:10,040 --> 00:23:13,200
would need to be changed out. 
But even then, talking four or 

401
00:23:13,200 --> 00:23:15,840
five, six hours till you would 
need to do that. 

402
00:23:15,840 --> 00:23:20,160
Did you look at using 2 oxygen 
portable oxygen generators and 

403
00:23:20,160 --> 00:23:22,640
having AT shape or a Daisy 
chain? 

404
00:23:22,640 --> 00:23:25,880
Or is there any way that you 
could have two six litre 

405
00:23:26,000 --> 00:23:28,680
portable oxygen canisters make 
12? 

406
00:23:28,800 --> 00:23:31,120
Yes. 
And actually there were a few 

407
00:23:31,120 --> 00:23:35,000
different articles that they had
come across that they actually 

408
00:23:35,000 --> 00:23:38,360
did that, just without the 
closed circuit system. 

409
00:23:38,360 --> 00:23:44,360
So they wired 2 oxygen 
concentrators into a vent just 

410
00:23:44,360 --> 00:23:47,240
to see what Fio 2 they were able
to achieve. 

411
00:23:47,240 --> 00:23:49,360
So yes, that is that is an 
option. 

412
00:23:49,360 --> 00:23:54,040
However, being the austere 
critical care programme, I was 

413
00:23:54,040 --> 00:23:58,720
trying to come up with things 
that were not super resource 

414
00:23:58,720 --> 00:24:01,160
dependent. 
I suppose if you are blessed to 

415
00:24:01,160 --> 00:24:05,120
have a couple different oxygen 
concentrators, then obviously we

416
00:24:05,120 --> 00:24:08,680
you could achieve much higher 
FIO 2 for those extended 

417
00:24:08,680 --> 00:24:10,760
durations. 
I was trying to keep in the back

418
00:24:10,760 --> 00:24:13,960
of my mind though that you'd 
probably be limited on equipment

419
00:24:13,960 --> 00:24:17,400
and even if you had one 
concentrator you you would be 

420
00:24:17,400 --> 00:24:20,120
considered lucky. 
But yes, there there were a few 

421
00:24:20,120 --> 00:24:23,000
articles that I came across that
did test that. 

422
00:24:23,080 --> 00:24:26,400
I don't believe any one of them 
did that with a closed circuit 

423
00:24:26,400 --> 00:24:28,520
system. 
But obviously as you bump up 

424
00:24:28,560 --> 00:24:35,840
your leader flow then your Sky's
the limit, probably for FI O2 

425
00:24:35,880 --> 00:24:37,600
using one of those type 
circuits. 

426
00:24:38,080 --> 00:24:40,960
So looking at your experience 
through the Masters of Austria 

427
00:24:40,960 --> 00:24:44,840
Critical Care, what were some of
the challenges you faced on this

428
00:24:44,840 --> 00:24:45,440
programme? 
Well. 

429
00:24:45,440 --> 00:24:49,920
I know personally for me, time 
management and depending on what

430
00:24:49,920 --> 00:24:52,880
I was doing and where I was in 
the world, it has always been a 

431
00:24:52,880 --> 00:24:56,920
challenge for me and I've never 
been, I suppose, a great 

432
00:24:56,920 --> 00:24:59,240
student. 
So I kind of had to reel myself 

433
00:24:59,240 --> 00:25:03,840
back in and make sure that I was
getting assignments done on a 

434
00:25:03,840 --> 00:25:06,600
timely basis. 
But honestly, the programme made

435
00:25:06,600 --> 00:25:09,040
it easy. 
It was kind of, you know, go at 

436
00:25:09,040 --> 00:25:11,760
your own pace. 
So in that case it made it easy.

437
00:25:11,760 --> 00:25:14,400
It was more just when it came 
down to the thesis, I kind of 

438
00:25:14,400 --> 00:25:17,080
had to create my own timeline 
for things. 

439
00:25:17,080 --> 00:25:20,280
So that was a just a personal 
challenge, but some people are 

440
00:25:20,280 --> 00:25:22,320
better at that. 
But honestly, the rest of the 

441
00:25:22,320 --> 00:25:25,320
programme was great. 
I didn't really come across too 

442
00:25:25,320 --> 00:25:27,920
many challenges. 
Maybe one of the ones that I'd 

443
00:25:27,920 --> 00:25:32,440
come across that I think we had 
chatted about as you would do 

444
00:25:32,440 --> 00:25:35,680
kind of evals as the programme 
would go along was just because 

445
00:25:35,680 --> 00:25:37,600
we all come from different parts
of the world. 

446
00:25:37,600 --> 00:25:41,520
Sometimes syncing up time and 
getting responses about this or 

447
00:25:41,520 --> 00:25:43,320
that. 
Again, just because of time 

448
00:25:43,320 --> 00:25:45,600
differences and schedules and 
whatnot. 

449
00:25:45,600 --> 00:25:49,320
Sometimes those were 
challenging, but the staff at 

450
00:25:49,320 --> 00:25:52,800
Coram and your mentors going to 
the programme really made it a 

451
00:25:52,800 --> 00:25:56,080
point to questions as best as 
possible and as quick as 

452
00:25:56,080 --> 00:25:58,600
possible. 
So I think that's kind of just 

453
00:25:58,600 --> 00:26:02,120
an intrinsic type of thing. 
That's when you bring in people 

454
00:26:02,120 --> 00:26:05,480
from all over the world so that 
are still practising, which I 

455
00:26:05,480 --> 00:26:09,880
think is key for having people a
part of your programme doing the

456
00:26:09,880 --> 00:26:11,800
education. 
You got to have people that are 

457
00:26:11,800 --> 00:26:15,680
still doing doing the thing. 
So I think it just it comes with

458
00:26:15,680 --> 00:26:18,960
some of those challenges. 
How has this changed your 

459
00:26:18,960 --> 00:26:22,880
clinical practise? 
Well, definitely the immediate 

460
00:26:22,880 --> 00:26:26,520
change has been in any of the 
wilderness medicine education 

461
00:26:26,520 --> 00:26:29,040
that's kind of a direct 
corollary to that. 

462
00:26:29,160 --> 00:26:33,440
And then when I'm out doing your
military and tactical medicine 

463
00:26:33,440 --> 00:26:37,480
and injecting some of the 
prolonged field care lessons and

464
00:26:37,480 --> 00:26:41,200
whatnot, that's definitely a one
to one type of thing that I can 

465
00:26:41,200 --> 00:26:44,280
take straight from the ACC 
programme into that. 

466
00:26:44,320 --> 00:26:46,280
And then just the way you 
generally think about pre 

467
00:26:46,280 --> 00:26:49,800
hospital medicine that can be 
applied anywhere from ambulance 

468
00:26:49,920 --> 00:26:54,240
to an air evacuation platform 
and even in hospital depending 

469
00:26:54,240 --> 00:26:56,960
on where you're at. 
I haven't worked in a hospital, 

470
00:26:56,960 --> 00:26:59,240
but definitely anywhere in 
Montana. 

471
00:26:59,240 --> 00:27:01,360
They we call it frontier 
medicine out here. 

472
00:27:01,360 --> 00:27:05,400
So a lot of this could be 
applicable even if you do have 4

473
00:27:05,400 --> 00:27:06,920
walls and bright lights around 
you. 

474
00:27:07,000 --> 00:27:09,200
Nice. 
Well, yeah, let me let me ask 

475
00:27:09,200 --> 00:27:12,440
you this. 
So somebody waves a magic wand 

476
00:27:12,560 --> 00:27:17,160
and you and I change seat. 
So now I get to live in rural, 

477
00:27:17,160 --> 00:27:21,320
rugged Montana, right on the 
border of Canada, being a remote

478
00:27:21,320 --> 00:27:25,400
paramedic, and you're stuck in 
the office as Dean emeritus of 

479
00:27:25,400 --> 00:27:28,200
Coram. 
How would you change the looking

480
00:27:28,200 --> 00:27:30,280
at the Masters of Austria 
Critical care? 

481
00:27:30,280 --> 00:27:33,160
What would what would you want 
to improve and what would you 

482
00:27:33,160 --> 00:27:38,480
put into the programme? 
Well, I definitely like the the 

483
00:27:38,480 --> 00:27:40,360
way that you guys are moving 
forward. 

484
00:27:40,440 --> 00:27:44,520
You've added a whole bunch more 
courses, elective type courses 

485
00:27:44,520 --> 00:27:46,720
to the programme that I had 
heard about in one of your other

486
00:27:46,720 --> 00:27:49,040
podcasts. 
I'm so kind of jealous that I 

487
00:27:49,040 --> 00:27:51,680
haven't been able to, I haven't 
had the opportunity to take 

488
00:27:51,680 --> 00:27:55,720
those, but I'm not sure I really
enjoyed kind of the way it is 

489
00:27:55,720 --> 00:27:58,960
and how everything's laid out 
with the eye care and your APIs 

490
00:27:58,960 --> 00:28:01,920
courses and all the other things
that are offered that students 

491
00:28:01,920 --> 00:28:04,440
are able to take during the 
programme. 

492
00:28:04,440 --> 00:28:06,560
I, I think you guys got a good 
thing going. 

493
00:28:06,560 --> 00:28:09,680
I don't, I don't necessarily 
know if I would change much. 

494
00:28:09,680 --> 00:28:13,040
I will say if you, if we swap 
seats, you better bring your 

495
00:28:13,040 --> 00:28:15,600
work gloves and Carharts out 
here because you're going to 

496
00:28:15,720 --> 00:28:19,080
you're going to work and 
definitely working in an office 

497
00:28:19,080 --> 00:28:21,880
is is not for me. 
I just came back from being away

498
00:28:21,880 --> 00:28:25,640
for about 3 weeks teaching 
various wilderness medicine and 

499
00:28:25,640 --> 00:28:31,000
EMT courses and sitting in my at
Home Office and I don't care for

500
00:28:31,000 --> 00:28:33,040
it. 
I'd rather I'd rather be out 

501
00:28:33,040 --> 00:28:34,920
doing the thing, teaching the 
thing. 

502
00:28:34,960 --> 00:28:38,120
You are teaching woofer with Doc
Pearson. 

503
00:28:38,680 --> 00:28:40,360
Yes, yes. 
Yeah. 

504
00:28:40,360 --> 00:28:44,280
So tell us how that was that in 
Taos or was that in Utah? 

505
00:28:44,400 --> 00:28:48,120
So that was in Utah, it was a 
couple hours east of Salt Lake 

506
00:28:48,120 --> 00:28:51,680
City where we were. 
So that was 1 woofer that I was 

507
00:28:51,680 --> 00:28:55,080
teaching and he, he's putting 
together an amazing programme. 

508
00:28:55,160 --> 00:28:58,120
Black Swan is the name of his 
organisation, but he had a 

509
00:28:58,120 --> 00:29:03,240
couple other docs there and then
between me and a couple other 

510
00:29:03,360 --> 00:29:07,640
people that were from the flight
in pre hospital realm helping 

511
00:29:07,640 --> 00:29:10,120
out teach the course. 
It was an amazing programme. 

512
00:29:10,120 --> 00:29:14,440
That was my first kind of foray 
into teaching a wilderness 

513
00:29:14,440 --> 00:29:18,360
medicine class and then since 
then I've done a couple other 

514
00:29:18,360 --> 00:29:21,800
with a few different programmes.
Everybody has their own flavour 

515
00:29:21,800 --> 00:29:25,600
on how they do things, but 
taking a lot of those lessons 

516
00:29:25,600 --> 00:29:28,840
from the ACC or just Quorum 
programmes that I've been 

517
00:29:28,840 --> 00:29:34,040
through, they definitely were 
happy and excited when I would 

518
00:29:34,040 --> 00:29:36,320
bring some of those things in a 
lot. 

519
00:29:36,320 --> 00:29:39,640
A lot of those are simple, you 
know, not resource intensive, so

520
00:29:39,640 --> 00:29:43,960
obviously they were a welcome 
addition to a wilderness type 

521
00:29:43,960 --> 00:29:46,240
course. 
So, William, what's next for 

522
00:29:46,240 --> 00:29:47,520
you? 
What's next? 

523
00:29:47,520 --> 00:29:51,840
Well, I just received my, I 
guess just got my foam approval.

524
00:29:51,840 --> 00:29:55,080
That'll go well done. 
Thank you that is that is not 

525
00:29:55,080 --> 00:29:56,200
easy mate. 
No. 

526
00:29:56,200 --> 00:29:58,400
And it but it was another one of
those things that I started 

527
00:29:58,400 --> 00:30:01,280
actually at the eye care. 
You guys had brought it up. 

528
00:30:01,280 --> 00:30:04,600
I didn't know much about the 
Wilderness Medical Society and I

529
00:30:04,600 --> 00:30:08,200
knew nothing about the foam 
programme and it was brought up 

530
00:30:08,200 --> 00:30:09,720
on one of the days for the eye 
care. 

531
00:30:09,720 --> 00:30:13,120
So I signed up, got that 
started, which was a huge, it 

532
00:30:13,120 --> 00:30:16,040
took a huge chunk out of the 
required credits. 

533
00:30:16,040 --> 00:30:19,640
So I'm glad that I did that. 
But yes, it's been a long time, 

534
00:30:19,680 --> 00:30:25,440
what, 3 1/2 years or so of work.
So I finally got that. 

535
00:30:25,440 --> 00:30:29,560
So I always joke it's, you know,
more letters to put after your 

536
00:30:29,560 --> 00:30:34,120
name and in some instances you 
kind of you need that just so 

537
00:30:34,120 --> 00:30:37,240
that people maybe take you more 
more seriously. 

538
00:30:37,360 --> 00:30:41,800
No, it was an amazing programme.
Definitely glad that I was able 

539
00:30:41,800 --> 00:30:44,200
to complete that. 
And they have plenty of other 

540
00:30:44,200 --> 00:30:47,640
opportunities to continue and go
past the farm. 

541
00:30:47,640 --> 00:30:50,840
So planning on doing that. 
As far as moving forward, I 

542
00:30:51,000 --> 00:30:54,240
going to continue doing 
wilderness medicine and 

543
00:30:54,240 --> 00:30:57,080
education. 
So the woofer, the building, his

544
00:30:57,080 --> 00:31:02,640
first aid classes, I have some 
TC-3 and other classes, contract

545
00:31:02,640 --> 00:31:06,520
classes coming up here. 
And then my quote unquote day 

546
00:31:06,520 --> 00:31:12,120
job is managing pre hospital 
education for a company in in 

547
00:31:12,120 --> 00:31:14,280
Kalispell in the Flathead Valley
area. 

548
00:31:14,280 --> 00:31:16,640
So that'll keep me busy for a 
little bit. 

549
00:31:17,440 --> 00:31:21,480
You know, to be fair, the form 
credential is, I hold it in high

550
00:31:21,480 --> 00:31:25,160
regard, so if I'm looking at 
what someone published or if I 

551
00:31:25,400 --> 00:31:28,720
have, we get applications all 
the time for teaching and when I

552
00:31:28,720 --> 00:31:33,040
see the form it means something.
It's not something you just buy.

553
00:31:33,240 --> 00:31:35,680
There's so many crappy 
fellowships out there that 

554
00:31:35,800 --> 00:31:39,080
here's a few £100. 
Oh great, I've got an F after my

555
00:31:39,080 --> 00:31:42,560
name and, and I mean there's a 
lot that aren't by any means, 

556
00:31:42,680 --> 00:31:44,640
but you have to work for the 
farm. 

557
00:31:44,800 --> 00:31:48,400
And that's one reason why I have
jumped through the hoops for 

558
00:31:48,520 --> 00:31:53,160
what, 15-17 years now working 
with WMS, making sure that our 

559
00:31:53,160 --> 00:31:57,480
programmes are credited for 
farm, because I believe that 

560
00:31:57,480 --> 00:32:02,440
having your fellowship with WMS 
makes you a better well-rounded 

561
00:32:02,560 --> 00:32:04,600
clinician in the wilderness. 
Absolutely. 

562
00:32:04,600 --> 00:32:10,160
Yeah, I couldn't agree anymore. 
And all of the things that you 

563
00:32:10,280 --> 00:32:12,760
can get approved for credit 
wise. 

564
00:32:12,880 --> 00:32:15,240
And then they have a teaching 
component, which was actually 

565
00:32:15,240 --> 00:32:19,480
kind of why I went out to Utah 
to do the woofer class because 

566
00:32:19,480 --> 00:32:22,120
they were offering FOM teaching 
credit. 

567
00:32:23,080 --> 00:32:25,440
Nice. 
There's just so many things that

568
00:32:25,440 --> 00:32:30,120
they allow you to do and ask of 
you to get that form. 

569
00:32:30,120 --> 00:32:32,680
It's definitely, it's definitely
a process, something you have to

570
00:32:32,680 --> 00:32:34,880
keep up with because they do 
have a time limit. 

571
00:32:35,000 --> 00:32:39,480
But yes, I do I agree. 
It's more than just paying to 

572
00:32:39,480 --> 00:32:41,800
have some letters come after 
your name. 

573
00:32:41,880 --> 00:32:45,040
You have to put a lot more work 
into it than that. 

574
00:32:45,080 --> 00:32:46,480
I agree. 
It's one of those things that 

575
00:32:46,480 --> 00:32:50,120
when you're looking at somebody 
in the wilderness medicine realm

576
00:32:50,120 --> 00:32:51,960
and they have that, it's like, 
oh, OK. 

577
00:32:52,080 --> 00:32:57,440
And even more so if you're, if 
you're not a doc, I would say a 

578
00:32:57,440 --> 00:33:02,040
lot of things for the WMS are 
sometimes more geared towards 

579
00:33:02,040 --> 00:33:05,240
your doctors. 
But definitely if you have foam 

580
00:33:05,240 --> 00:33:08,080
and you know you're not, you're 
not a doc, just all of that 

581
00:33:08,200 --> 00:33:11,560
extra stuff that's required of 
you, I feel like definitely 

582
00:33:11,560 --> 00:33:14,600
holds you hold you in a little 
bit higher, higher regard. 

583
00:33:14,600 --> 00:33:17,200
I feel like in pre hospital 
medicine for sure. 

584
00:33:20,000 --> 00:33:22,640
It's been quite the journey 
going through that. 

585
00:33:22,680 --> 00:33:25,880
Indeed. 
So William, my final question 

586
00:33:25,880 --> 00:33:28,520
for you is this. 
What advice do you have for the 

587
00:33:28,520 --> 00:33:32,360
new medic, the new nurse, the 
new Doctor who is just starting 

588
00:33:32,360 --> 00:33:34,920
out in their career in austere 
medicine? 

589
00:33:34,920 --> 00:33:37,040
I would say just continue to 
learn. 

590
00:33:37,040 --> 00:33:42,040
Listen, listen to everybody who 
may be speaking in front of you.

591
00:33:42,040 --> 00:33:46,600
Also reach out and try to find 
those people that are doing that

592
00:33:46,600 --> 00:33:49,200
thing. 
This is a passion of yours being

593
00:33:49,200 --> 00:33:52,000
in the wilderness and you're 
somebody that comes from the 

594
00:33:52,000 --> 00:33:56,840
medical field or vice versa. 
Just keep seeking out 

595
00:33:56,920 --> 00:33:59,000
information. 
Keep going to classes. 

596
00:33:59,000 --> 00:34:02,560
It's quite, quite the realm that
you're getting into. 

597
00:34:02,680 --> 00:34:07,280
And just because we learn how to
do X thing in an ambulance or in

598
00:34:07,360 --> 00:34:11,760
a hospital, it doesn't always 
work out that way out in the 

599
00:34:11,760 --> 00:34:14,400
wilderness. 
So I just feel like again, being

600
00:34:14,400 --> 00:34:18,320
being a forever student and you 
can always learn from anybody 

601
00:34:18,320 --> 00:34:21,239
who's around you, no matter 
student or educator. 

602
00:34:21,239 --> 00:34:24,880
That's good advice and it has 
been great to have you on the 

603
00:34:24,880 --> 00:34:27,520
podcast, William. 
And and it was fantastic to 

604
00:34:27,520 --> 00:34:31,800
shake your hand last January as 
you walked across the stage and 

605
00:34:31,800 --> 00:34:34,639
earned a Masters of Austere 
critical. 

606
00:34:34,639 --> 00:34:39,120
Care it was amazing to do that 
and I appreciate everything that

607
00:34:39,120 --> 00:34:40,840
you've done for me in the 
college abric. 

608
00:34:40,840 --> 00:34:45,199
So thank you very much again for
inviting me on to this platform 

609
00:34:45,199 --> 00:34:48,199
that you have. 
This has been a presentation 

610
00:34:48,360 --> 00:34:50,639
from the College of Remote and 
Offshore Medicine. 

611
00:34:51,320 --> 00:34:55,080
If you would like to earn CPD 
credits for this podcast, you 

612
00:34:55,080 --> 00:34:58,720
can join the Council of Members.
Being a member of the College 

613
00:34:58,720 --> 00:35:02,560
gives you free CPD credit, free 
access for a virtual field 

614
00:35:02,560 --> 00:35:05,400
guide, and discounts on our 
e-learning courses. 

615
00:35:05,800 --> 00:35:11,200
You can join the team on our 
college website at coram.edu dot

616
00:35:11,200 --> 00:35:11,720
Mt.