Wilderness emergency medical technician
Encyclopedia
Wilderness Emergency Medical Technician, or WEMT, is the second highest level of wilderness emergency medical
training available in the USA (second to Wilderness Advanced Life Support (WALS)), or other courses for advanced providers such as AWLS, and RMAP (Remote Medicine for Advanced Providers). In addition to an urban EMT-Basic course, WEMT places a greater emphasis on long-term patient care in the backcountry
where conventional hospital care can take days to reach. Some of the main providers of Wilderness EMT training in the United States include Wilderness Medical Associates (WMA), the Wilderness Medical Institute (National Outdoor Leadership School
), Center for Wilderness Safety, SOLO
, and Remote Medical International
.
began teaching the principles of first aid at mining sites and near large railway centers. By the dawn of the 20th century, additional organizations such as the Boy Scouts
and the American Red Cross
began teaching first aid to lay people. Over the years, these organizations trained hundreds of thousands of people in the elements of providing assistance until definitive care could be arranged. The training in these courses assumed that definitive care was nearby and could be delivered quickly. Eventually there was a realization that this training, while valuable, needed to be supplemented and/or revised to deal with the extended time and limited resources inherent when a medical crisis occurs in a wilderness setting. In the 1950s organizations such as The Mountaineers
began developing training programs that addressed these special needs. In 1966, the US Government, through the National Traffic and Motor Vehicle Safety Act
, gave the Department of Transportation
(DOT) responsibility for creating a national Emergency Medical Services System (EMS). From this program came the standardized curriculum for the position of Emergency Medical Technician
(EMT). The first Wilderness EMT course was taught in 1976 to help EMTs in Colorado
adapt their skills and knowledge when working with Search and Rescue teams. By 1977 organizations such as Stonehearth Open Learning Opportunities
(SOLO) and Wilderness Medical Associates were offering specialized Wilderness First Aid training to their instructors. Meanwhile the DOT EMS program recognized a need to develop standardized training for "first responders" such as truck drivers, policemen and fireman who could lend assistance during the initial part of "golden hour" until an ambulance with an EMT arrived. In 1984 SOLO developed and taught the first Wilderness First Responder
course. The purpose of creating the course was to provide Rangers, outdoor leaders, and guides the necessary knowledge to provide care in crisis situations in the wilderness. In 1985, SOLO began providing WFR training to Outward Bound
instructors in Florida. Today WFR certification is frequently a pre-requisite for professional positions that involve work in the outdoors.
curriculum. Most schools also allow for other health care professionals, such as RNs, MDs, or Paramedics, to become wilderness certified, but the curriculum is the same. Often a student will have to travel a long distance to attend a WEMT class, and as a result, most WEMT classes involve taking classes 8–10 hours per day for one or more weeks (depending on whether the student is already an EMT).
There is a strong focus on rendering aid with improvised means (for instance, using a branch and some rope to splint an injured extremity rather than using commercially available splinting devices). In wilderness settings it is unlikely that the specialized equipment found in an ambulance will be available, so the focus is on using only what is at hand in your assessment and care for a patient. There is also a greater focus on long-term care, since a WEMT may have to be with a patient for many hours, while most urban EMTs are with each patient for no more than an hour (at the most).
Providing care in the wild can be a daunting task, since the golden hour
is usually out of the question, and one may have to treat or stabilize a critical patient for hours until help arrives or you can get them the care they need. Backcountry medicine often speaks of the golden day—a patient's survival chances for critical injuries drastically drop off around 24 hours without hospital care.
WEMT's and Wilderness First Responder
can perform more advanced interventions, such as giving patients prescribed medications outside the scope of an urban EMT or First Responder with off-line medical direction. Some of these medications include hydrocodone
, oxycodone
, cefalexin
, fluconazole
, and acetazolamide
all depending on what standing orders the WEMT or WFR has.
WEMTs also are allowed some acts outside the scope of practice of urban EMTs, such as stopping CPR after all efforts have been exhausted, dislocation reductions and ruling out spinal injuries.
In contrast, Wilderness EMT courses are available in Ireland
and the United Kingdom
but are not recognised by the respective governing bodies for pre-hospital care.
Wilderness medicine
Wilderness medicine is defined by difficult patient access, limited equipment, and environmental extremes. Today, wilderness or expedition medicine is practiced by Wilderness First Responders, Wilderness EMTs, Remote/Offshore/Wilderness Paramedics and Physicians on expeditions, in outdoor...
training available in the USA (second to Wilderness Advanced Life Support (WALS)), or other courses for advanced providers such as AWLS, and RMAP (Remote Medicine for Advanced Providers). In addition to an urban EMT-Basic course, WEMT places a greater emphasis on long-term patient care in the backcountry
Backcountry
A backcountry area in general terms is a geographical region that is:* isolated* remote* undeveloped* difficult to accessThe term may apply to various regions that are reasonably close to urban areas but are:* not immediately accessible by car...
where conventional hospital care can take days to reach. Some of the main providers of Wilderness EMT training in the United States include Wilderness Medical Associates (WMA), the Wilderness Medical Institute (National Outdoor Leadership School
National Outdoor Leadership School
The National Outdoor Leadership School , is a non-profit outdoor education school based in the United States dedicated to teaching environmental ethics, technical outdoor skills, safety and judgment, and leadership on extended wilderness expeditions...
), Center for Wilderness Safety, SOLO
Stonehearth Open Learning Opportunities
Stonehearth Open Learning Opportunities is a school based in Conway, New Hampshire dedicated to wilderness medicine and outdoor leadership training. Founded by Dr. Frank Hubbell in 1976, it was one of the first schools to offer education on wilderness emergency medicine...
, and Remote Medical International
Remote Medical International
Remote Medical International is a wilderness medicine education and services provider located in Seattle, Washington...
.
History
Near the end of the 19th century, volunteer organizations such as St. John AmbulanceSt. John Ambulance
St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...
began teaching the principles of first aid at mining sites and near large railway centers. By the dawn of the 20th century, additional organizations such as the Boy Scouts
Scouting
Scouting, also known as the Scout Movement, is a worldwide youth movement with the stated aim of supporting young people in their physical, mental and spiritual development, that they may play constructive roles in society....
and the American Red Cross
American Red Cross
The American Red Cross , also known as the American National Red Cross, is a volunteer-led, humanitarian organization that provides emergency assistance, disaster relief and education inside the United States. It is the designated U.S...
began teaching first aid to lay people. Over the years, these organizations trained hundreds of thousands of people in the elements of providing assistance until definitive care could be arranged. The training in these courses assumed that definitive care was nearby and could be delivered quickly. Eventually there was a realization that this training, while valuable, needed to be supplemented and/or revised to deal with the extended time and limited resources inherent when a medical crisis occurs in a wilderness setting. In the 1950s organizations such as The Mountaineers
The Mountaineers (Pacific NW)
The Mountaineers is an outdoor recreation, education, and conservation group based in Seattle, Washington and is the third largest group of its kind in the country. Its central Program Center located in Seattle's Magnuson Park is complete with education facilities for all aspects of the alpine...
began developing training programs that addressed these special needs. In 1966, the US Government, through the National Traffic and Motor Vehicle Safety Act
National Traffic and Motor Vehicle Safety Act
The National Traffic and Motor Vehicle Safety Act was enacted in the United States in 1966 to empower the federal government to set and administer new safety standards for motor vehicles and road traffic safety. The Act created the National Highway Safety Bureau...
, gave the Department of Transportation
United States Department of Transportation
The United States Department of Transportation is a federal Cabinet department of the United States government concerned with transportation. It was established by an act of Congress on October 15, 1966, and began operation on April 1, 1967...
(DOT) responsibility for creating a national Emergency Medical Services System (EMS). From this program came the standardized curriculum for the position of Emergency Medical Technician
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
(EMT). The first Wilderness EMT course was taught in 1976 to help EMTs in Colorado
Colorado
Colorado is a U.S. state that encompasses much of the Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains...
adapt their skills and knowledge when working with Search and Rescue teams. By 1977 organizations such as Stonehearth Open Learning Opportunities
Stonehearth Open Learning Opportunities
Stonehearth Open Learning Opportunities is a school based in Conway, New Hampshire dedicated to wilderness medicine and outdoor leadership training. Founded by Dr. Frank Hubbell in 1976, it was one of the first schools to offer education on wilderness emergency medicine...
(SOLO) and Wilderness Medical Associates were offering specialized Wilderness First Aid training to their instructors. Meanwhile the DOT EMS program recognized a need to develop standardized training for "first responders" such as truck drivers, policemen and fireman who could lend assistance during the initial part of "golden hour" until an ambulance with an EMT arrived. In 1984 SOLO developed and taught the first Wilderness First Responder
Wilderness First Responder
Wilderness First Responders are individuals who are trained to respond to emergency situations in remote settings. They are part of a wide variety of wilderness medical professionals who deal with medical emergencies that occur in wilderness settings....
course. The purpose of creating the course was to provide Rangers, outdoor leaders, and guides the necessary knowledge to provide care in crisis situations in the wilderness. In 1985, SOLO began providing WFR training to Outward Bound
Outward Bound
Outward Bound is an international, non-profit, independent, outdoor educationorganization with approximately 40 schools around the world and 200,000 participants per year...
instructors in Florida. Today WFR certification is frequently a pre-requisite for professional positions that involve work in the outdoors.
Training
WEMT training is not standardized and varies by state and school but typically involves around 50 hours of wilderness medicine training in addition to traditional EMT-B certification. All WEMTs have valid National Registry EMT or state certified EMTs before joining a course, unless the course also incorporates the urban Emergency Medical TechnicianEmergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
curriculum. Most schools also allow for other health care professionals, such as RNs, MDs, or Paramedics, to become wilderness certified, but the curriculum is the same. Often a student will have to travel a long distance to attend a WEMT class, and as a result, most WEMT classes involve taking classes 8–10 hours per day for one or more weeks (depending on whether the student is already an EMT).
There is a strong focus on rendering aid with improvised means (for instance, using a branch and some rope to splint an injured extremity rather than using commercially available splinting devices). In wilderness settings it is unlikely that the specialized equipment found in an ambulance will be available, so the focus is on using only what is at hand in your assessment and care for a patient. There is also a greater focus on long-term care, since a WEMT may have to be with a patient for many hours, while most urban EMTs are with each patient for no more than an hour (at the most).
Providing care in the wild can be a daunting task, since the golden hour
Golden hour (medicine)
In emergency medicine, the golden hour refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death...
is usually out of the question, and one may have to treat or stabilize a critical patient for hours until help arrives or you can get them the care they need. Backcountry medicine often speaks of the golden day—a patient's survival chances for critical injuries drastically drop off around 24 hours without hospital care.
WEMT's and Wilderness First Responder
Wilderness First Responder
Wilderness First Responders are individuals who are trained to respond to emergency situations in remote settings. They are part of a wide variety of wilderness medical professionals who deal with medical emergencies that occur in wilderness settings....
can perform more advanced interventions, such as giving patients prescribed medications outside the scope of an urban EMT or First Responder with off-line medical direction. Some of these medications include hydrocodone
Hydrocodone
Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
, oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
, cefalexin
Cefalexin
Cefalexin or more commonly cephalexin is a first-generation cephalosporin antibiotic introduced in 1967 by Eli Lilly and Company. It is an orally administered agent with a similar antimicrobial spectrum to the intravenous agents cefalotin and cefazolin...
, fluconazole
Fluconazole
Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. In a bulk powder form, it appears as a white crystalline powder, and it is very slightly soluble in water and soluble in alcohol. It is commonly marketed under the trade...
, and acetazolamide
Acetazolamide
Acetazolamide, sold under the trade name Diamox, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, Idiopathic intracranial hypertension , altitude sickness, cystinuria, and dural ectasia...
all depending on what standing orders the WEMT or WFR has.
WEMTs also are allowed some acts outside the scope of practice of urban EMTs, such as stopping CPR after all efforts have been exhausted, dislocation reductions and ruling out spinal injuries.
In contrast, Wilderness EMT courses are available in Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
and the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
but are not recognised by the respective governing bodies for pre-hospital care.
See also
- Wilderness first aid
- Wilderness First ResponderWilderness First ResponderWilderness First Responders are individuals who are trained to respond to emergency situations in remote settings. They are part of a wide variety of wilderness medical professionals who deal with medical emergencies that occur in wilderness settings....
- Emergency medical technicianEmergency medical technicianEmergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...